Despite medical progress, high morbidity and mortality rates, due primarily to cardiovascular diseases, have persisted in patients with end-stage renal disease (ESRD). Recently, nontraditional risk factors, such as inflammation and malnutrition, have been emphasized in the development or progression of atherosclerosis in ESRD patients. Depression, the most common psychological problem in the ESRD population, is also known to be associated with inflammation and malnutrition, suggesting a possible link between depression with inflammation and cardiovascular diseases. The purpose of this study was to investigate the relationship between depression with cardiovascular risk factors and inflammation in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Eighty-one stable CAPD patients were enrolled. Depressive symptoms were assessed with the Beck Depression Inventory. Various cardiovascular risk factors and inflammatory markers were measured. Forty-three patients had depressive symptoms (53.8%). Patients with depressive symptoms showed significantly lower levels of albumin and IL-10, but higher levels of inflammatory markers than patients without depressive symptoms. Left ventricular hypertrophy was also found more frequently and pulse wave velocity and asymmetric dimethylarginine were all significantly increased in patients with depressive symptoms. Depression in CAPD patients was associated with inflammation and cardiovascular risk factors, and might be used as a predictor of cardiovascular diseases.

1.
Xue JL, Ma JZ, Louis TA, Collins AJ: Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. J Am Soc Nephrol 2001;12:2753–2758.
2.
Goldsmith D: Negative outcome studies in end-stage renal disease. Blood Purif 2008;26:63–66.
3.
Guerin AP, Pannier B, Marchais SJ, London GM: Cardiovascular disease in the dialysis population: prognostic significance of arterial disorders. Curr Opin Nephrol Hypertens 2006;15:105–110.
4.
Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD: Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis 2003;42:864–881.
5.
Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G: Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant 2004;19:1507–1519.
6.
Ersoy FF: Improving technique survival in peritoneal dialysis: what is modifiable? Perit Dial Int 2009;29(Suppl 2):S74–S77.
7.
Wuerth D, Finkelstein SH, Finkelstein FO: The identification and treatment of depression in patients maintained on dialysis. Semin Dial 2005;18:142–146.
8.
Odden MC, Whooley MA, Shlipak MG: Depression, stress, and quality of life in persons with chronic kidney disease: the Heart and Soul Study. Nephron Clin Pract 2006;103:c1–c7.
9.
Lopes AA, Bragg J, Young E, Goodkin D, Mapes D, Combe C, Piera L, Held P, Gillespie B, Port FK: Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. Kidney Int 2002;62:199–207.
10.
Kimmel PL, Weihs K, Peterson RA: Survival in hemodialysis patients: the role of depression. J Am Soc Nephrol 1993;4:12–27.
11.
Chilcot J, Wellsted D, Da Silva-Gane M, Farrington K: Depression on dialysis. Nephron Clin Pract 2008;108:c256–c264.
12.
Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, Veis JH: Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients. Kidney Int 1998;54:245–254.
13.
Ruberman W, Weinblatt E, Goldberg JD, Chaudhary BS: Psychosocial influences on mortality after myocardial infarction. N Engl J Med 1984;311:552–559.
14.
Micozkadioglu H, Micozkadioglu I, Zumrutdal A, Erdem A, Ozdemir FN, Sezer S, Haberal M: Relationship between depressive affect and malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrology (Carlton) 2006;11:502–505.
15.
Kalender B, Ozdemir AC, Koroglu G: Association of depression with markers of nutrition and inflammation in chronic kidney disease and end-stage renal disease. Nephron Clin Pract 2006;102:c115–c121.
16.
Dervisoglu E, Kir HM, Kalender B, Eraldemir C, Caglayan C: Depressive symptoms and proinflammatory cytokine levels in chronic renal failure patients. Nephron Clin Pract 2008;108:c272–c277.
17.
Tonelli M, Sacks F, Pfeffer M, Jhangri GS, Curhan G: Biomarkers of inflammation and progression of chronic kidney disease. Kidney Int 2005;68:237–245.
18.
Fan PL, Shu CH, Shiang JC, Kuo TS, Lung FW: Hypertension – a possible vulnerability marker for depression in patients with end-stage renal disease. Nephron Clin Pract 2006;102:c43–c50.
19.
Vallance P: Importance of asymmetrical dimethylarginine in cardiovascular risk. Lancet 2001;358:2096–2097.
20.
Madore F: Uremia-related metabolic cardiac risk factors in chronic kidney disease. Semin Dial 2003;16:148–156.
21.
Craven JL, Rodin GM, Littlefield C: The Beck Depression Inventory as a screening device for major depression in renal dialysis patients. Int J Psychiatry Med 1988;18:365–374.
22.
Grant D, Almond MK, Newnham A, Roberts P, Hutchings A: The Beck Depression Inventory requires modification in scoring before use in a haemodialysis population in the UK. Nephron Clin Pract 2008;110:c33–c38.
23.
Guney I, Biyik M, Yeksan M, Biyik Z, Atalay H, Solak Y, Selcuk NY, Tonbul HZ, Turk S: Sleep quality and depression in peritoneal dialysis patients. Ren Fail 2008;30:1017–1022.
24.
Yang JY, Huang JW, Peng YS, Chiang SS, Yang CS, Yang CC, Chen HW, Wu MS, Wu KD, Tsai TJ, Chen WY: Quality of sleep and psychosocial factors for patients undergoing peritoneal dialysis. Perit Dial Int 2007;27:675–680.
25.
Novak M, Shapiro CM, Mendelssohn D, Mucsi I: Diagnosis and management of insomnia in dialysis patients. Semin Dial 2006;19:25–31.
26.
Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J: Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the Restless Legs Syndrome Diagnosis and Epidemiology Workshop at the National Institutes of Health. Sleep Med 2003;4:101–119.
27.
Kimmel PL: Psychosocial factors in dialysis patients. Kidney Int 2001;59:1599–1613.
28.
Chilcot J, Wellsted D, Vilar E, Farrington K: An association between residual renal function and depression symptoms in haemodialysis patients. Nephron Clin Pract 2009;113:c117–c124.
29.
Shimbo D, Davidson KW, Haas DC, Fuster V, Badimon JJ: Negative impact of depression on outcomes in patients with coronary artery disease: mechanisms, treatment considerations, and future directions. J Thromb Haemost 2005;3:897–908.
30.
Barisic I, Pivac N, Muck-Seler D, Jakovljevic M, Sagud M: Comorbid depression and platelet serotonin in hemodialysis patients. Nephron Clin Pract 2004;96:c10–c14.
31.
Rugulies R: Depression as a predictor for coronary heart disease. A review and meta-analysis. Am J Prev Med 2002;23:51–61.
32.
Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, Newman MF: Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med 2004;66:305–315.
33.
Ibrahim S, El Salamony O: Depression, quality of life and malnutrition-inflammation scores in hemodialysis patients. Am J Nephrol 2008;28:784–791.
34.
Tomfohr LM, Martin TM, Miller GE: Symptoms of depression and impaired endothelial function in healthy adolescent women. J Behav Med 2008;31:137–143.
35.
Selley ML: Increased (e)-4-hydroxy-2-nonenal and asymmetric dimethylarginine concentrations and decreased nitric oxide concentrations in the plasma of patients with major depression. J Affect Disord 2004;80:249–256.
36.
von Kanel R, Hepp U, Traber R, Kraemer B, Mica L, Keel M, Mausbach BT, Schnyder U: Measures of endothelial dysfunction in plasma of patients with posttraumatic stress disorder. Psychiatry Res 2008;158:363–373.
37.
Pinto VL, Brunini TM, Ferraz MR, Okinga A, Mendes-Ribeiro AC: Depression and cardiovascular disease: role of nitric oxid. Cardiovasc Hematol Agents Med Chem 2008;6:142–149.
38.
Tsirpanlis G: Is inflammation the link between atherosclerosis and vascular calcification in chronic kidney disease? Blood Purif 2007;25:179–182.
39.
Dantzer R: Cytokine-induced sickness behavior: where do we stand? Brain Behav Immun 2001;15:7–24.
40.
Dantzer R, Aubert A, Bluthe RM, Gheusi G, Cremona S, Laye S, Konsman JP, Parnet P, Kelley KW: Mechanisms of the behavioural effects of cytokines. Adv Exp Med Biol 1999;461:83–105.
41.
Koo JR, Yoon JY, Joo MH, Lee HS, Oh JE, Kim SG, Seo JW, Lee YK, Kim HJ, Noh JW, Lee SK, Son BK: Treatment of depression and effect of antidepression treatment on nutritional status in chronic hemodialysis patients. Am J Med Sci 2005;329:1–5.
42.
Yang CC, Jick SS, Jick H: Lipid-lowering drugs and the risk of depression and suicidal behavior. Arch Intern Med 2003;163:1926–1932.
43.
Maes M: Major depression and activation of the inflammatory response system. Adv Exp Med Biol 1999;461:25–46.
44.
Gul A, Aoun N, Trayner EM Jr: Why do patients sleep on dialysis? Semin Dial 2006;19:152–157.
45.
Bilgic A, Akgul A, Sezer S, Arat Z, Ozdemir FN, Haberal M: Nutritional status and depression, sleep disorder, and quality of life in hemodialysis patients. J Ren Nutr 2007;17:381–388.
46.
Molnar MZ, Szentkiralyi A, Lindner A, Czira ME, Szeifert L, Kovacs AZ, Fornadi K, Szabo A, Rosivall L, Mucsi I, Novak M: Restless legs syndrome and mortality in kidney transplant recipients. Am J Kidney Dis 2007;50:813–820.
47.
Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, Veis JH: Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int 2000;57:2093–2098.
48.
Giordano M, Tirelli P, Ciarambino T, Gambardella A, Ferrara N, Signoriello G, Paolisso G, Varricchio M: Screening of depressive symptoms in young-old hemodialysis patients: relationship between Beck Depression Inventory and 15-item Geriatric Depression Scale. Nephron Clin Pract 2007;106:c187–c192.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.