title: The relationship between depressive symptoms and erythropoietin resistance in stable hemodialysis patients with adequate iron stores.
abstract: BACKGROUND
  Resistance to erythropoietin (EPO) treatment has been associated with inflammation and malnutrition in hemodialysis (HD) patients. Depression has also been associated with both inflammation and malnutrition; however, the specific relationship between depressive symptoms and EPO resistance is not known. In the current study, the relationship between depressive symptoms and EPO resistance as evaluated by erythropoiesis stimulating agent (ESA) hyporesponsiveness index (EHRI) was analyzed.
  
  
  METHODS
  Study participants had their medical history taken and underwent physical examination; dialysis adequacy calculation, biochemical analysis and evaluation of depressive symptoms by Beck Depression Inventory (BDI) were performed. EHRI was calculated as the weekly dose of EPO divided by per kilogram of body weight divided by the hemoglobin level.
  
  
  RESULTS
  The mean BDI score of the patients was 10.99 ± 3.94. Pearson correlation analysis revealed that the logarithmically converted EHRI score was correlated with albumin (r = -0.270, p = 0.011), hs-CRP (r = 0.383, P<0.0001), hemoglobin (r = -0.617, p<0.0001), intact PTH (r = 0.215, p = 0.043) and logarithmically converted BDI (r = 0.299, p = 0.004). The stepwise linear regression analysis revealed that being female (p = 0.012), presence of diabetes mellitus (p = 0.119), hs-CRP (p = 0.009) and BDI score (p = 0.037) were independently related with logarithmically converted EHRI (as a dependent variable).
  
  
  CONCLUSIONS
  Depressive symptoms were independently related with EHRI in HD patients. Studies are needed to highlight underlying mechanisms between depression and EHRI.
authors: Department of Medicine, Division of Nephrology, Konya Numune State Hospital, Konya, Turkey. afsarbrs@yahoo.com
authors: Baris
authors: B
authors: Afsar
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000209:etiology*; D004351:Drug Resistance; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000097:blood*; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin; D000068817:Epoetin Alfa; D007501:Iron