Relationship between a pro- and anti-inflammatory cytokine imbalance and depression in haemodialysis patients.
OBJECTIVE
Depression represents the most frequent psychiatric disorder in patients on maintenance haemodialysis (HD), and it might be associated with secretion of inflammatory cytokines. In this study, we explore the possible correlations between depression and pro-inflammatory (IL-1β, IL-6, and TNF-α), anti-inflammatory (IL-10) cytokines, as well as high-sensitivity C-reactive protein (hs-CRP) serum levels.


METHODS
Eighty three HD patients were enrolled in this cross-sectional study. Depressive symptoms were measured with the Beck Depression Inventory (BDI), and 'elevated symptoms of depression' were defined as a BDI score of ≥16. Biochemical parameters (serum albumin, haemoglobin, ferritin, etc.) and dialysis dosage delivery (kt/v) were assessed. Serum IL-1β, IL-6, IL-10, TNF-α, and hs-CRP levels were measured using an ELISA method. Thirty two, healthy, age- and sex-matched individuals were included as the control group.


RESULTS
The prevalence of depression in HD patients was 61.4%. HD Patients with symptoms of depression had lower educational levels compared to non-depressed ones (P = 0.02), but did not differ with respect to age, gender, time on dialysis program, marital status, or smoking habits. Depressed patients also had significantly higher serum levels of IL-6, the IL-6-to-IL-10 ratio, as well as lower haemoglobin levels (P = 0.003, P = 0.002, and P = 0.02 respectively). No differences in mean serum IL-1β, IL-10, TNF-α, or hs-CRP concentrations were noted between the two groups. The BDI scores showed a significant, positive correlation with serum levels of IL-1β (P = 0.03), IL-6 (P = 0.001), TNF-α (P = 0.02), the IL-6-to-IL-10 ratio (P = 0.001), and a negative correlation with haemoglobin levels (P = 0.02).


CONCLUSIONS
Maintenance HD patients with symptoms of depression may have higher serum levels of IL-6, a IL-6-to-IL-10 ratio, and lower haemoglobin concentrations. An imbalance between pro- and anti-inflammatory cytokines may play an important role in the pathogenesis of depression in HD patients.
Faculty of Pharmacy, Tehran Universiyt of Medical Sciences, Tehran, Iran.
Mohammad
M
Taraz
Mohammad-Reza
MR
Khatami
Afshin
A
Gharekhani
Alireza
A
Abdollahi
Hossein
H
Khalili
Simin
S
Dashti-Khavidaki
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000097:blood*; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood*; D003710:Demography; D003863:Depression / Q000097:blood*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000523:psychology*; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D016207:Cytokines; D018836:Inflammation Mediators
anti-inflammatory cytokines; depression; haemodialysis; haemoglobin; pro-inflammatory cytokines