A systematic review and meta-analysis of the evidence on inflammation in depressive illness and symptoms in chronic and end-stage kidney disease

Abstract

Background Depression affects approximately 27% of adults with chronic kidney disease (CKD) and end-stage kidney failure (ESKF). Depression in this population is associated with impaired quality of life and increased mortality. The extent of inflammation and the impact on depression in CKD/ESKF is yet to be established. Through a systematic literature review and meta-analysis, we aim to understand the relationship between depression and inflammation in CKD/ESKF patients. Methods We searched nine electronic databases for published studies until January 2022. Titles and abstracts were screened against inclusion and exclusion criteria. Data extraction and study quality assessment was carried out independently by two reviewers. A meta-analysis was carried out where appropriate; otherwise a narrative review of studies was completed. Results Sixty studies met our inclusion criteria and entered the review (9481 patients included in meta-analysis). Meta-analysis of cross-sectional associations revealed significantly higher levels of pro-inflammatory biomarkers; C-reactive protein; Interleukin 6 (IL-6) and tumour necrosis factor-alpha in patients with depressive symptoms (DS) compared to patients without DS. Significantly lower levels of anti-inflammatory cytokine IL-10 were found in patients with DS compared to patients without DS. Considerable heterogeneity was detected in the analysis for most inflammatory markers. Conclusion We found evidence for an association of higher levels of pro-inflammatory and lower anti-inflammatory cytokines and DS in patients with CKD/ESKF. Clinical trials are needed to investigate whether anti-inflammatory therapies will be effective in the prevention and treatment of DS in these patients with multiple comorbidities.

Are abnormalities in lipid metabolism, together with adverse childhood experiences, the silent causes of immune-linked neurotoxicity in major depression?

“…It is observed that inpatients diagnosed with MDD (IMDD), the majority of whom suffer from very severe MDD and melancholia, exhibit indications of an immune response, including activation of M1 macrophages, T helper (Th)1, Th2 and Th17 immune cells, and an acute phase response with increased levels of acute phase proteins, complement factors, and pro-inflammatory cytokines, e.g., interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α [1–3]. These findings have been extensively replicated and published in various meta-analyses [4–8].…”

Effect of a Virtual Reality Exercise on Patients Undergoing Haemodialysis: A Randomised Controlled Clinical Trial Research Protocol

“…Psychological problems are also very frequent in these patients, presenting a prevalence of depression of 27%, which is associated with impaired quality of life and increased mortality. Besides, there is evidence of an association of higher pro-inflammatory and lower anti-inflammatory cytokine levels and depressive symptoms in patients with CKD/CKF [28]. In this sense, exercise offers great benefits to improve both inflammatory levels and associated depressive symptoms [18,29].…”

Inflammatory Determinants and Associated Morbidity in Hemodialysis Patients

“…In contrast, research involving patients on substitution therapy reported that lower levels of IL-10 were associated with depressive symptoms [ 23 ]. A recent meta-analysis of end-stage CKD [ 24 ] found that subjects with depressive symptoms had a pattern of elevated proinflammatory IL-6 and low concentrations of anti-inflammatory IL-10. These authors ascribed the discrepant results between studies to heterogeneity in the analyses and to some individuals’ previously observed genetic proneness to an increased inflammatory response [ 23 ].…”