Association between depression and inflammatory/anti‐inflammatory cytokines in chronic kidney disease and end‐stage renal disease patients: A review of literature

Abstract

Depression is a common psychiatric disorder in patients with advanced chronic kidney diseases (CKDs). Strong correlation has been reported between depression and patients' morbidity and mortality among dialysis patients. On the contrary, chronic inflammation may be a major contributor to morbidity and mortality in these patients. Elevated plasma levels of proinflammatory cytokines, especially C-reactive protein and interleukin (IL)-6, have been correlated with cardiovascular events, hospitalization, and all-cause and cardiovascular-associated mortality in dialysis patients. Studies suggested that inflammation-mediated atherosclerotic cardiovascular diseases are the possible reasons for depression-induced mortality among patients without renal diseases. Several studies found significant elevations in circulating levels of proinflammatory cytokines, particularly IL-6 and tumor necrosis factor-α, in patients with major depression. Furthermore, depressive mood and behaviors, including sadness and suicidal ideation, were observed in patients who received repeated injections of recombinant cytokines. A thorough literature review indicates that while depressive symptoms and elevated inflammatory cytokine levels coexist in CKD and dialysis patients, their association is uncertain. Depression seems to be more associated with elevated serum levels of IL-6 than other cytokines in these patients. Further studies are needed to clarify the possibility of a causal relationship between inflammation and depressive symptoms in CKD and dialysis patients.

Anxiety and depression in patients with end-stage renal disease: impact and management challenges – a narrative review

“…3,54 This can lead to alterations in malnutrition, immunity, inflammation, and atherosclerosis states. 55 This theory was also supported by early evidence that depression could be involved in the development of malnutrition, inflammation, and atherosclerosis (MIA) in patients undergoing dialysis. 56 Second, depression might also be associated with clinical outcomes via behavioral pathways.…”

Update on Inflammation in Chronic Kidney Disease

“…Pro-inflammatory cytokines may directly cause anorexia via influence on the brain. In addition, inflammatory markers, particularly IL-6, may be associated with depression in CKD and ESRD, which by itself is a predictor of morbidity and mortality [24] and can cause decreased nutrient intake. However, inflammation may not only cause true malnutrition, but can also increase resting energy expenditure.…”

Depression in dialysis patients

“…Depression may result in adverse clinical outcomes by affecting compliance with dialysis and medication regimes, alteration of immune system function, and its detrimental effect on nutritional status . Depressed dialysis patients had significantly elevated plasma levels of pro‐inflammatory cytokines, in particular interleukin (IL)‐6, which may be associated with adverse cardiovascular outcomes . A recent randomized, double‐blind, placebo‐controlled trial showed that 12‐week treatment with sertraline significantly decreased serum IL‐6 levels in HD patients with depression .…”