Depression but not anxiety is associated with iron deficiency anemia for patients with stage 2-4 CKD

Ozant Helvaci; Ilgin  Genc; M. Hakan Aksu; Saliha Yildirim; Emre Yasar

doi:10.18203/2320-6012.ijrms20244103

Authors

Ozant Helvaci Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey https://orcid.org/0000-0002-1382-2439
Ilgin Genc Gazi University Faculty of Medicine, Ankara, Turkey
M. Hakan Aksu Department of Psychiatry, Gazi University Faculty of Medicine, Ankara, Turkey https://orcid.org/0000-0003-2930-5337
Saliha Yildirim Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey https://orcid.org/0000-0002-2693-1167
Emre Yasar Gazi University Faculty of Medicine, Department of Nephrology, Ankara, Turkey https://orcid.org/0000-0001-8271-1831

DOI:

https://doi.org/10.18203/2320-6012.ijrms20244103

Keywords:

Anxiety, Chronic kidney disease, Depression, Iron deficiency anemia, Iron supplementation

Abstract

Background: Chronic kidney disease (CKD) is a global health challenge, often complicated by iron deficiency anemia (IDA), depression, and anxiety. While the impact of IDA on depression has been well-documented, its association with anxiety in non-dialysis-dependent CKD patients remains unclear. This study aimed to investigate the relationship between IDA and neuropsychiatric disorders, specifically depression and anxiety, in patients with non-dialysis-dependent CKD stages 2-4.

Methods: A cross-sectional study was conducted in the outpatient nephrology clinic at Gazi University Hospital, enrolling 200 patients with stable CKD (stages 2-4). Depression and anxiety were measured using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. Statistical analysis included comparisons of BDI and BAI scores between anemic and non-anemic groups, along with subgroup analysis of iron-treated anemic patients.

Results: Anemia was present in 38% of patients, and anemic patients had significantly higher BDI scores (mean 13.4 vs. 9.0, p<0.001) than non-anemic patients, indicating a greater prevalence of depressive symptoms. No significant differences were found in BAI scores between the groups. However, anemic patients receiving iron supplementation had lower BDI and BAI scores compared to untreated anemic patients (p<0.001).

Conclusions: IDA was associated with a higher prevalence of depression but not anxiety in non-dialysis CKD patients. Iron supplementation may help mitigate depressive symptoms in this population. Further prospective studies are needed to explore the full potential of iron therapy in managing mental health outcomes in CKD patients.

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References

Borg R, Carlson N, Søndergaard J, Persson F. The growing challenge of chronic kidney disease: an overview of current knowledge. Inter J Nephrol. 2023;2023(1):9609266.

Hussien H, Apetrii M, Covic A. Health-related quality of life in patients with chronic kidney disease. Expert Rev Pharmacoecon Outc Res. 2021;21(1):43-54.

Gafter-Gvili A, Schechter A, Rozen-Zvi B. Iron Deficiency Anemia in Chronic Kidney Disease. Acta Haematolog. 2019;142(1):44-50.

Xu S, Wang J, Sun K, Meng L, Qin C, Feng R, et al. Cognitive impairment in chronic kidney disease is associated with glymphatic system dysfunction. Kidney diseases (Basel, Switzerland). 2023;9(5):384-97.

Bahall M, Legall G, Lalla C. Depression among patients with chronic kidney disease, associated factors, and predictors: a cross-sectional study. BMC Psych. 2023;23(1):733.

Alshelleh S, Alhouri A, Taifour A, Abu-Hussein B, Alwreikat F, Abdelghani M, et al. Prevelance of depression and anxiety with their effect on quality of life in chronic kidney disease patients. Sci Rep. 2022;12(1):17627.

Lee HS, Chao HH, Huang WT, Chen SC, Yang HY. Psychiatric disorders risk in patients with iron deficiency anemia and association with iron supplementation medications: a nationwide database analysis. BMC Psych. 2020;20(1):216.

8. Yin R, Gao Q, Fu G, Zhao Q. The causal effect of iron status on risk of anxiety disorders: A two-sample Mendelian randomization study. PloS one. 2024;19(3):e0300143.

Pretto CR, Winkelmann ER, Hildebrandt LM, Barbosa DA, Colet CF, Stumm EMF. Quality of life of chronic kidney patients on hemodialysis and related factors. Revista latino-americana de enfermagem. 2020;28:e3327.

Sheng YP, Ma XY, Liu Y, Yang XM, Sun FY. Independent risk factors for depression in older adult patients receiving peritoneal dialysis for chronic kidney disease. World J Psych. 2023;13(11):884-92.

Tekindal M, Tekindal MA. Validity and reliability of basic depression scale for Turkey. Batı Karadeniz Tıp Dergisi. 2021;5(3):452-63.

Ulusoy M, hisli sahin N, Erkmen H. Turkish version of the beck anxiety inventory: psychometric properties. J Cogn Psychoth:An Inter Quarterly. 1998;12.

Tsai YC, Chiu YW, Hung CC, Hwang SJ, Tsai JC, Wang SL, et al. Association of symptoms of depression with progression of CKD. Amer J Kid Dis: J Nat Kid Foundat. 2012;60(1):54-61.

Zheng X, Wu W, Shen S. Prospective bidirectional associations between depression and chronic kidney diseases. Scient Rep. 2022;12(1):10903.

Lee YJ, Kim HB. Association between anaemia and adult depression: a systematic review and meta-analysis of observational studies. J Epidemiol Commu Health. 2020;74(7):565-72.

Feroze U, Martin D, Kalantar-Zadeh K, Kim JC, Reina-Patton A, Kopple JD. Anxiety and depression in maintenance dialysis patients: preliminary data of a cross-sectional study and brief literature review. J Ren Nutrit: J Council on Renal Nutr Nat Kid Foundat. 2012;22(1):207-10.

Pereira AA, Weiner DE, Scott T, Sarnak MJ. Cognitive function in dialysis patients. Amer J Kid Dis: J Nat Kid Foundat. 2005;45(3):448-62.

Berthou C, Iliou JP, Barba D. Iron, neuro-bioavailability and depression. E J Haem. 2022;3(1):263-75.