Abstract
Introduction: Depression is the most prevalent psychological problem among hemodialysis (HD) patients. Inflammatory factors have been reported to play an important role in the pathogenesis of depression. The association between depression and inflammatory factors was established in chronic kidney disease (CKD) patients. Sertraline, a selective serotonin reuptake inhibitor (SSRI) antidepressant, decreases serum levels of inflammatory factors in patients with depression. Objectives: This study was designed to assess the effect of sertraline on serum concentration of C-reactive protein (CRP), hemoglobin and albumin of depressed hemodialysis (HD) patients. Patients and Methods: During a clinical trail, 35 depressed HD patients, and CRP >5 were allocated to receive sertraline for 12 weeks. Patients’ depression was assessed using Beck depression inventory second edition (BDI-II) biochemical parameters (hemoglobin, serum albumin, etc) and CRP levels were measured at baseline and at weeks 4, 8 and 12 of the study. BDI-II score was evaluated before and after 12 weeks treatment with sertraline. Results: Sertraline significantly improved depression symptoms in HD patients. At the end of the study, BDI-II scores significantly changed from baseline (P=0.001) and serum levels of CRP significantly decreased at week 12 of initiation of the study (P=0.001). However, the concentration of hemoglobin and serum albumin concentration and weight was not changed significantly (P=0.995 and P=0.328, respectively). Conclusion: Sertraline significantly decreases CRP levels and can be a promising strategy to reduce the systemic inflammation and to treat depression in HD patients.
Highlights
Depression is the most prevalent psychological problem among hemodialysis (HD) patients
This study was designed to assess the effect of sertraline on serum concentrations of C-reactive protein (CRP), hemoglobin and albumin of depressed HD patients
chronic kidney disease (CKD) is an inflammatory condition which is associated with an increasing in acute phase reactants, such as circulating inflammatory cytokines and C-reactive protein (CRP) and decreasing in negative acute phase reactants, such as serum albumin and fetuin [1]
Summary
Chronic kidney disease (CKD) is a range of different pathophysiologic processes lead to abnormal renal function and decline in glomerular filtration rate. Zahed NS et al undergoing chronic HD and associated with atherosclerosis, cardiovascular diseases, malnutrition and increased mortality rate [4]. Some previous studies detected increasing inflammatory markers such as CRP, interleukins, ferritin and erythrocyte sedimentation rate (ESR) in CKD patients, leading to deterioration of depression and subsequent malnutrition, atherosclerosis, cardiovascular morbidity and mortality in ESRD patients [7,8]. Hematocrit and albumin were lower among ESRD patients without major depression [9] It seems that reduction in inflammatory factors in ESRD patients could reduce depression and subsequently decreases cardiovascular events and mortality rate [10]. In the general population treatment with sertraline reduced the pro-inflammatory cytokines like IL2, IL4 and increased the anti-inflammatory cytokines [18]
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