Depression, Inflammation, and Oxidative Stress in Peritoneal Dialysis Patients: Is There a Relationship?

Korean Journal of Nephrology 2010;29(3):342-349.

Ho Sik Shin, M.D.1, Si-Sung Park, M.D.2, Ji Yong Park, M.D.2, Eun Young Lee, M.D.1, Nam Young Park, M.D.1, Yeon Soon Jung, M.D.1 and Hark Rim, M.D.1

Department of Internal Medicine¹
Department of Psychiatry²
Kosin University College of Medicine

원저 : 복막투석 환자에서 우울증의 양상과 산화스트레스와의 연관성

신호식1 , 박시성2 , 박지용2 , 이은영1 , 박남영1 , 정연순1 , 임 학1

고신대학교 의과대학 내과학교실1 , 정신과학교실2

Abstract

Purpose : This study aimed to investigate the features and severity of depressive symptoms in peritoneal dialysis patients, and the relationship of depressive symptoms with levels of inflammation and oxidative stress (OS). Methods : The diagnosis of depression was made using DSM-IV-TR and the depressive symptoms were evaluated using the Hamilton Rating Scale for Depression (HRSD) via a semi-structured interview. Levels of thiobarbituric acid-reactive substances (TBARs) were determined as markers of lipid peroxidation. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities were measured as antioxidants. Results : 19 (28.8%) patients were diagnosed with depression (Major Depressive Disorder was 18.2%, Dysthymic disorder was 10.6%). OS markers were not different between patients with and without depression. Compared to non-depressed patients, depressed patients showed significantly higher depressed mood, feelings of guilt, suicidal ideation, sleep disturbances, psychomotor retardation, agitation, psychic and somatic anxiety, lower levels of work and activities, gastrointestinal and general somatic symptoms, and hypochondriasis. There was a significant positive correlation between HRSD scores and peritonitis (γ=0.297, p=0.016), levels of high sensitivity C-reactive protein (hsCRP) (γ=0.406, p=0.001) and ferritin (γ=0.276, p=0.025), while there was a significant negative correlation between scores of HRSD and levels of albumin (γ=−0.313, p=0.010). Conclusion : Major depressive disorder and dysthymic disorder were not related to inflammation and oxidative stress in peritoneal dialysis patients; however, depressive symptom severity was correlated with markers of inflammation and malnutrition. These results suggest that inflammation could have influence on depressive symptoms in peritoneal dialysis patients.

Key Words: Peritoneal dialysis, Oxidative stress, Depression