Close correlation between the ankle-brachial index and symptoms of depression in hemodialysis patients

Abstract

BackgroundAs both of peripheral arterial disease (PAD) and depression carried a poor prognosis in patients on maintenance hemodialysis (MHD), we investigated the correlation between the ankle-brachial index (ABI), an indicator of subclinical PAD, and symptoms of depression in patients on MHD.MethodsOne hundred and twenty-nine patients on MHD (75 males and 54 females, mean age 64.8 ± 12 years) were enrolled in this cross-sectional study, which aimed at evaluating the relationship between symptoms of depression and ABI. Demographic as well as clinical and laboratory variables including status of diabetes, chronic hepatitis C infection, dialysis duration, Charlson comorbidity index (CCI), plasma levels of albumin, C-peptide, insulin, high-sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), adiponectin, and lipid profile were obtained. The self-administered beck depression inventory (BDI) was used to determine the presence or absence of symptoms of depression, and depression was defined as a BDI score ≧14. Multivariable-adjusted linear regression models were constructed to confirm the independent association of biologic parameters of symptoms of depression. Significance was defined as P < 0.05. Statistical analyses were performed using SPSS/Windows software (SPSS Science, v. 15.0, Chicago, IL).ResultsThe mode of multivariate analysis showed that diabetes (β = 3.594; P = 0.040), hepatitis C infection (β = 4.057; P = 0.008), levels of serum albumin (β = −5.656; P = 0.024), C-peptide (β = −0.292; P = 0.002), ABI (β = −9.041; P = 0.031), and Ln-transformed hsCRP were significantly associated with BDI.ConclusionsHepatitis C infection, serum levels of albumin, C-peptide, and ABI levels were found to be correlated with BDI (P < 0.05).

Inverse association between serum albumin and depressive symptoms among drug-free individuals with a recent suicide attempt

“…We only found an association between albumin levels and depressive symptoms in older adults (aged 45 years). This is actually consistent with many of the previous studies reporting a significant association, since samples investigated mainly have had mean age of >40 years [10,[12][13][14][15][16][17][18][19][20][21][22]43], while studies on samples aged <40 years predominantly did not observe any significant association between albumin and depressive symptoms [24][25][26][27].…”

“…Thus, the low albumin levels could be a result of depression with inflammatory markers. However, according to some works, the correlation between lower serum albumin and depressive symptoms were independent of immunological markers like CRP and IL-6 [14][15][16][17][18][19][20][21][22].…”

“…This is interesting, as there is some evidence for the relationship between lower albumin levels and attempted suicide [30], which is an important risk group for completed suicide [2][3][4]. These findings, taken together with the well-replicated negative association between depressive symptoms and albumin [10,[12][13][14][15][16][17][18][19][20][21][22][23], raise the issue whether there may be an association between albumin and depressive symptoms among individuals with a recent suicide attempt. Therefore, we aimed in this study to investigate the association between more severe depressive symptoms an important risk factor for suicide [2,28,29] and serum albumin among patients with attempted suicide.…”

“…Among others, patients with major depressive disorder (MDD) appear to have lower serum albumin levels compared to controls [9][10][11][12][13], increasing with anti-depressant therapy [8]. Lower serum albumin levels have also been linked to more severe depressive symptoms in various cohorts of patients with non-psychiatric diseases like stroke, HIV, multiple sclerosis (MS), chronic kidney disease, hemodialysis patients, hypertension or cancer [10,[12][13][14][15][16][17][18][19][20][21][22]. Interestingly, according to several studies, the negative association between serum albumin and depressive symptoms may be independent of immunological markers like CRP and IL-6 [14][15][16][17][18][19][20][21][22].…”

Depression and quality of life in older adults on hemodialysis

“…Hypoalbuminemia is a marker of poor prognosis in HD patients, being associated with depression, poor outcomes and higher mortality. 22,23 In our study, we observed that patients with serum albumin levels o 3.8 g/dL were twice as likely to be depressed. Low levels of serum albumin may reflect malnutrition, which is a risk factor for depression in older people.…”