Association between uremic toxins and depression in patients with chronic kidney disease undergoing maintenance hemodialysis

Heng Jung Hsu, Chiung Hui Yen, Chih Ken Chen, I. Wen Wu, Chin Chan Lee, Chiao Yin Sun, Shu Ju Chang, Chia Chi Chou, Ming Fang Hsieh, Chun Yu Chen, Chiao Ying Hsu, Chi Jen Tsai, Mai Szu Wu

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13 Citations (Scopus)

Abstract

Objective: Patients with chronic kidney disease (CKD) who are undergoing maintenance hemodialysis have a higher prevalence of depression than the general population. The underlying cause of this association is unknown, but may be related to accumulation of uremic toxins. Little is known about the association of accumulation of uremic toxins and depression in hemodialysis patients. Method: We conducted a cross-sectional study of 209 CKD patients from a single institution to evaluate the associations of a soluble small uremic toxin (urea), a soluble large uremic toxin (β2 microglobulin) and two protein-bound uremic toxins [total p-cresol sulfate (PCS) and indoxyl sulfate (IS)] with the presence of depression. Results: A total of 47 patients (22.4%) had depression. Depressive patients had lower body mass index, lower serum creatinine, lower serum albumin and lower total IS. Univariate and multivariate logistic regression analyses that adjusted for age, gender and other statistically significant variables indicated that depression was significantly and independently associated with lower serum albumin and lower total IS. The levels of urea, β2 microglobulin and PCS were not significantly associated with depression. Conclusion: Our results indicate that depression in patients with CKD was significantly and independently associated with lower serum albumin and lower total IS. However, the pathological mechanisms underlying these associations are unknown.

Original languageEnglish
Pages (from-to)23-27
Number of pages5
JournalGeneral Hospital Psychiatry
Volume35
Issue number1
DOIs
Publication statusPublished - Jan 2013

Keywords

  • β2 Microglobulin
  • Chronic kidney disease
  • Depression
  • Hemodialysis
  • Indoxyl sulfate
  • P-Cresol sulfate

ASJC Scopus subject areas

  • Psychiatry and Mental health

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    Hsu, H. J., Yen, C. H., Chen, C. K., Wu, I. W., Lee, C. C., Sun, C. Y., Chang, S. J., Chou, C. C., Hsieh, M. F., Chen, C. Y., Hsu, C. Y., Tsai, C. J., & Wu, M. S. (2013). Association between uremic toxins and depression in patients with chronic kidney disease undergoing maintenance hemodialysis. General Hospital Psychiatry, 35(1), 23-27. https://doi.org/10.1016/j.genhosppsych.2012.08.009