C reactive protein and depressive symptoms in hemodialysis patients: A questionable association

Abstract

Introduction: Patients with advanced chronic kidney disease (CKD) on haemodialysis (HD) may have increased C reactive protein (CRP) values and depressive symptoms. There is debate about the strength and nature of previously reported associations. We investigated these issues in a cohort of patients on HD. Methods: We screened for depressive symptoms using two valadiated depression screening tools: the Beck Depression Inventory‐II (BDI‐II), Patient Health Questionnaire (PHQ‐9). Demographic and clinical correlates of depression symptoms were eveluated in adjusted linear and logistic regression models, which included extra renal comorbidity and high CRP (>5 mg/L). Findings: Three hundred and ninety‐six HD patients were studied; 63.1% male, mean age 63.1 ± 16.4 years, median CRP 6 (5–15) mg/L. Depression scores were similar in those with normal and high CRP (BDI‐II (9(5–17) vs. 11(6–20)) or PHQ (4(2–9) vs. 6(2–10)). In adjusted multivariable regression BDI‐II scores were associated with previous history of depression (β 10.8, P < 0.001), serum albumin (β 0.41, P < 0.001), anuria (β 2.4, P < 0.037), diabetes (β 2.7, P = 0.033), and age (β −0.10, P = 0.009). High CRP was not independently associated with BDI‐II (β 2.20, P = 0.057), though was with PHQ‐9 (β 1.20, P = 0.046). In logistic regression those with high CRP were 1.9 times more likely to score ≥16 on BDI‐II screening (P = 0.016), but did not relate significantly to a PHQ‐score ≥10. Discussion: A relationship was observed between CRP and depression symptoms, though the effect was small, of unlikely clinical significance, and inconsistent between depression measures. Previous reports of this association may reflect overlap between symptoms of depression and advanced CKD.

Postdialysis recovery time is extended in patients with greater self‐reported depression screening questionnaire scores

“…Other studies have reported longer recovery times, and postdialysis fatigue linked to inflammation, increased serum phosphate and calcium . We found no such associations.…”

“…Other studies have reported longer recovery times, and postdialysis fatigue linked to inflammation, increased serum phosphate and calcium. 20,28 We found no such associations. Previously we have demonstrated that CRP is not strongly linked with self-reported depression scores.…”

Depression Symptoms in Haemodialysis Patients Predict All-Cause Mortality but Not Kidney Transplantation: A Cause-Specific Outcome Analysis

“…CRP and depression have been the focus of past studies, with some showing a positive association between depression and inflammation [ 22 , 23 ]. This association might explain the observed attenuation of the effect between depression and survival with respect to the PHQ-9 cut-off score, although it should be acknowledged that the association between inflammation and depression in ESKF is mixed [ 24 , 25 ].…”

Association of Depressive Symptoms with Iron Management in Patients on Maintenance Hemodialysis: A Cross-sectional Study

“…Serum albumin levels and CRP, which are important indexes of biomarkers in HD patients, were not found to be associated with depressive symptoms in the present study. Several other studies have shown that lower serum albumin levels and higher CRP caused depressive symptoms [36][37][38]. However, further prospective trials may be required to examine the impact of nutritional and inflammation status upon depressive symptoms in HD patients and to determine whether serum albumin levels and higher CRP are associated with depressive symptoms.…”