Volume 6, Issue 2, June 2020, Page: 48-54
Association of Depressive Symptoms with Iron Management in Patients on Maintenance Hemodialysis: A Cross-sectional Study
Yoshihiro Tsuji, Department of Medical Engineering, Faculty of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
Naoki Suzuki, Department of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
Yasumasa Hitomi, Department of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
Yuko Mizuno-Matsumoto, Graduate School of Applied Informatics, University of Hyogo, Kobe, Japan
Toshiko Tokoro, Department of Nephrology, Tojinkai Satellite Clinic, Kyoto, Japan
Masato Nishimura, Cardiovascular Division, Tojinkai Satellite Clinic, Kyoto, Japan
Received: May 5, 2020;       Accepted: Jun. 15, 2020;       Published: Jun. 29, 2020
DOI: 10.11648/j.ijbecs.20200602.14      View  285      Downloads  71
Background: Iron status has a critical role in depressive symptoms, but evaluation of depressive symptoms associated with iron metabolism is not usually included as a clinical parameter in hemodialysis (HD) patients. We aimed to assess the correlations between depressive symptoms and clinical, demographic, and laboratory variables including iron metabolism. Methods: One hundred and thirty-eight HD patients were evaluated in this study. The Beck Depression Inventory Second Edition (BDI−II) was used to quantify levels of depressive symptoms. BDI−II scores ≥ 14 were defined as depressive symptoms. Mean age, duration of HD, haemoglobin levels, serum ferritin levels, serum iron levels, transferrin saturation (TSAT), total iron binding capacity, serum albumin levels, and C-reactive protein were included in the model. Patients were categorized into four groups according to serum ferritin levels and TSAT. Backward stepwise logistic regression analysis was performed and odds ratios (ORs) and 95% confidence intervals derived. Results: Depressive symptoms were significantly associated with increased serum ferritin levels (OR, 1.010; p=0.0008). Compared with group 1 (ferritin <100 ng/dL, TSAT ≥20%) as reference, ORs for depressive symptoms were significantly increased in group 4 (ferritin ≥100 ng/dL, TSAT < 20%) (OR, 6.419; p=0.0073). Conclusion: Higher serum ferritin levels and decreased iron utilization efficiency were found to be involved in depressive symptoms among patients undergoing HD. Understanding the pathophysiology of depressive symptoms could provide insights into the design of clinical iron management in HD patients.
Depressive Symptoms, Hemodialysis, Iron Management
To cite this article
Yoshihiro Tsuji, Naoki Suzuki, Yasumasa Hitomi, Yuko Mizuno-Matsumoto, Toshiko Tokoro, Masato Nishimura, Association of Depressive Symptoms with Iron Management in Patients on Maintenance Hemodialysis: A Cross-sectional Study, International Journal of Biomedical Engineering and Clinical Science. Vol. 6, No. 2, 2020, pp. 48-54. doi: 10.11648/j.ijbecs.20200602.14
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This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
R Kimmel PL. Psychosocial factors in adult end-stage renal disease patients treated with hemodialysis: correlates and outcomes. Am J Kidney Dis 2000; 35: S132–S140J.
Kimmel PL. Psychosocial factors in dialysis patients. Kidney Int 2001; 59: 1599–1613.
Lopes AA, Bragg J, Young E, et al. Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. Kidney Int 2002; 62: 199–207.
Kimmel PL, Weihs K, Peterson RA. Survival in hemodialysis patients: the role of depression. J Am Soc Nephrol 1993; 4: 12–27.
Beard JL, Connor JR, Jones BC. Iron in the brain. Nutr Rev 1993; 51: 157–170.
Roncagliolo M, Garrido M, Walter T, Peirano P, Lozoff B. Evidence of altered central nervous system development in infants with iron deficiency anaemia at 6 mo: delayed maturation of auditory brainstem responses. Am J Clin Nutr 1998; 68: 683–690.
Tracey A. Rouault. Iron metabolism in the CNS: implications for neurodegenerative diseases. Nature reviews. Neuroscience, 2013; 14 (8): 551-564.
Vahdat Shariatpanaahi M, Vahdat Shariatpanaahi Z, Moshtaaghi M, Shahbaazi SH, Abadi A. The relationship between depression and serum ferritin level. Eur J Clin Nutr 2007; 61: 532–535.
Baune BT, Eckardstein AV, Berger K. Lack of association between iron metabolism and depressive mood in an elderly general population. Int Psychogeriatr 2006; 18: 337–444.
Hunt JR, Penland JG. Iron status and depression in premenopausal women: an MMPI study. Minnesota Multiphasic Personality Inventory. Behav Med 1999; 25: 62–68.
Baune BT, Neuhauser H, Ellert U, Berger K. The roles of inflammatory workers ferritin, transferrin and fibrinogen in the relationship between major depression and cardiovascular disorders — The German Health Interview and Examination Survey. Acta Psychiatr Scand 2010; 121: 135–142.
Yamada K, Furuya R, Takita T, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr 2008; 87: 106–113.
Matsuzawa Y, Tokunaga K, Kotani K, Keno Y, Kobayashi T, Tarui S. Simple estimation of ideal body weight from body mass index with the lowest morbidity. Diabetes Res Clin Pract 1990; 10 Suppl 1: S159–S164.
Examination Committee of Criteria for 'Obesity Disease' in Japan; Japan Society for the Study of Obesity. New criteria for 'obesity disease' in Japan. Circ J 2002; 66: 987–992.
Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess 1996; 67: 588–597.
Wuerth D, Finkelstein SH, Ciarcia J, Peterson R, Kliger AS, Finkelstein FO. Identification and treatment of depression in a cohort of patients maintained on chronic peritoneal dialysis. Am J Kidney Dis 2001; 37: 1011–1017.
Kimmel PL, Peterson RA, Weihs KL, et al. Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int 2000; 57: 2093–2098.
Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. Psychological Corporation, San Antonio, TX: 1996.
Simic Ogrizovic S, Jovanovic D, Dopsaj V, et al. Could depression be a new branch of MIA syndrome? Clin Nephrol 2009; 71: 164–172.
Tsubakihara Y, Nishi S, Akiba T, et al. 2008 Japanese Society for Dialysis Therapy: guidelines for renal anaemia in chronic kidney disease. Ther Apher Dial 2010; 14: 240–275.
Klipstein-Grobusch K, Koster JF, Grobbee DE, et al. Serum ferritin and risk of myocardial infarction in the elderly: the Rotterdam Study. Am J Clin Nutr 1999; 69: 1231–1236.
Mezzano D, Pais EO, Aranda E, et al. Inflammation, not hyperhomocysteinemia, is related to oxidative stress and hemostatic and endothelial dysfunction in uremia. Kidney Int 2001; 60: 1844–1850.
Feldman HI, Santanna J, Guo W, et al. Iron administration and clinical outcomes in hemodialysis patients. J Am Soc Nephrol 2002; 13: 734–744.
Kimmel PL, Phillips TM, Simmens SJ, et al. Immunologic function and survival in hemodialysis patients. Kidney Int 1998; 54: 236–244.
Beamish MR, Davies AG, Eakins JD, Jacobs A, Trevett D. The measurement of reticuloendothelial iron release using iron-dextran. Br J Haematol 1971; 21: 617–622.
Macdougall IC, Hutton RD, Cavill I, Coles GA, Williams JD. Poor response to treatment of renal anaemia with erythropoietin corrected by iron given intravenously. BMJ 1989; 299: 157–158.
Stadler N, Lindner RA, Davies MJ. Direct detection and quantification of transition metal ions in human atherosclerotic plaques: evidence for the presence of elevated levels of iron and copper. Arterioscler Thromb Vasc Biol 2004; 24: 949–954. Epub 2004 Mar 4.
Drüeke T, Witko-Sarsat V, Massy Z, et al. Iron therapy, advanced oxidation protein products, and carotid artery intima-media thickness in end-stage renal disease. Circulation 2002; 106: 2212–2217.
Sipe JC, Lee P, Beutler E. Brain iron metabolism and neurodegenerative disorders. Dev Neurosci 2002; 24: 188–196.
Whitnall M, Richardson DR. Iron: a new target for pharmacological intervention in neurodegenerative diseases. Semin Pediatr Neurol 2006; 13: 186–197.
Madsen E, Gitlin JD. Copper and iron disorders of the brain. Annu Rev Neurosci 2007; 30: 317–337.
Sian-Hülsmann J, Mandel S, Youdim MB, Riederer P. The relevance of iron in the pathogenesis of Parkinson's disease. J Neurochem 2011; 118: 939–957.
Smith DG, Cappai R, Barnham KJ. The redox chemistry of the Alzheimer's disease amyloid beta peptide. Biochim Biophys Acta 2007; 1768: 1976–1990.
Raven EP, Lu PH, Tishler TA, Heydari P, Bartzokis G. Increased iron levels and decreased tissue integrity in hippocampus of Alzheimer's disease detected in vivo with magnetic resonance imaging. J Alzheimers Dis 2013; 37: 127–136.
Basu S, Mohan ML, Luo X, Kundu B, Kong Q, Singh N. Modulation of proteinase K-resistant prion protein in cells and infectious brain homogenate by redox iron: implications for prion replication and disease pathogenesis. Mol Biol Cell 2007; 18: 3302–3312. Epub 2007 Jun 13.
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: c115–121.
Chilcot J, Friedli K, Guirguis A, Wellsted D, Farrington K, Davenport A. C reactive protein and depressive symptoms in haemodialysis patients: A questionable association. Hemodial Int 2016 Sep 27. doi: 10.1111/hdi.12500. [Epub ahead of print].
Friend R, Hatchett L, Wadhwa NK, Suh H. Serum albumin and depression in end-stage renal disease. Adv Perit Dial 1997; 13: 155–157.
Yi S, Nanri A, Poudel-Tan dukar K, Nonaka D, Matsushita Y, Hori A, et al. Association between serum ferritin concentrations and depressive symptoms in Japanese municipal employees. Psychiatry research. 2011; 189 (3): 368–721.
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