What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Chronic kidney disease and end-stage kidney disease (n=6437). Intervention: Depression vs. Without depression. Primary outcome: Serum albumin levels (SMD -0.37, 95% CI -0.61 to -0.13).

December 21, 2019Kidney International ReportsOpen Access

A Systematic Review and Meta-Analysis of Depression and Protein–Energy Wasting in Kidney Disease

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Key result

The presence of depression in patients with kidney disease was associated with lower serum albumin levels (SMD -0.37) and higher levels of C-reactive protein and interleukin-6.

Why the study?

Depression comorbid with chronic disease may be mediated by inflammation, prompting characterization of relationships between inflammatory biomarkers and depressive symptoms in chronic kidney disease and end-stage kidney disease.

Are circulating inflammatory biomarkers associated with the presence and severity of depression in patients with chronic kidney disease or end-stage kidney disease?

Population

Patients with chronic kidney disease or end-stage kidney disease

Comparison

Individuals with vs without depression

Design

Systematic review and meta-analysis

Authors

LGL. Parker GreggBaylor College of Medicine TCThomas CarmodyMayo Clinic Health System DLDustin LeThomas Jefferson University

Discussion

Member takes

Implication

Supports incorporating inflammatory markers into depression assessment in CKD/ESKD; leaves open causality and treatment effects.

Study Design

Type

Meta-Analysis (n=6,437)

Structured PICO

Are circulating inflammatory biomarkers associated with the presence and severity of depression in patients with chronic kidney disease or end-stage kidney disease?

Population

6,437 patients with chronic kidney disease or end-stage kidney disease from 44 studies evaluating the association between circulating inflammatory biomarkers and depression.

Outcome

Standardized mean differences in circulating inflammatory biomarkers (albumin, CRP, high-sensitivity CRP, IL-6, TNF-α, IL-1) between individuals with and without depression, and correlations with depressive symptom severitysurrogate

Main Result

Standardized Mean Difference: -0.37 (95% CI -0.61–-0.13)

Inflammatory biomarkers such as lower albumin, higher IL-6, and CRP are associated with the presence and severity of depression in patients with kidney disease.

Limitations

Small sample sizes in individual studies
Variable instruments and thresholds used to define depression
Inadequate dosing or treatment duration of antidepressant medications in the included trials
Significant heterogeneity among the included studies
Lack of adjustment for covariates in most included observational studies
Heterogeneity across studies of IL-6
Insufficient studies to combine in meta-analysis for antidepressant treatment effect

Cite This Study

Gregg et al. (2019) conducted a meta-analysis in Chronic kidney disease and end-stage kidney disease (n=6,437). Depression vs. Without depression was evaluated on Serum albumin levels (SMD -0.37, 95% CI -0.61 to -0.13). The presence of depression in patients with kidney disease was associated with lower serum albumin levels (SMD -0.37) and higher levels of C-reactive protein and interleukin-6.

synapsesocial.com/papers/6a9effc771528e4baaf54d98 https://doi.org/10.1016/j.ekir.2019.12.009

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A Systematic Review and Meta-Analysis of Depression and Protein–Energy Wasting in Kidney Disease

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

A Systematic Review and Meta-Analysis of Depression and Protein–Energy Wasting in Kidney Disease

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider