Inflammatory Activity Is an Independent Predictor of Depression and Fatigue In

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Inflammatory Activity is an Independent Predictor of Depression and Fatigue in StableKidneyTransplant Recipients

Winnie Chan1,2, Anna Phillips2, David Jones3, Okdeep Kaur1, Philip McTernan4, Nicholas Inston1, Sue Moore1, Andrew McClean1, Lorraine Harper1, Richard Borrows1,2, Jos Bosch2.5

1Queen Elizabeth Hospital Birmingham; 2University of Birmingham; 3Manchester Metropolitan University; 4University of Warwick; 5University of Amsterdam

BACKGROUND:Animal studies have demonstrated potent neurological effects of inflammation, which include depressive-like and lethargic behaviours. While human data is sparse, these preclinical findings lead to the hypothesis that inflammatory activity may partly account for the high incidence of depression and fatigue in various chronic disease groups. The present study investigated if inflammatory activity predicts depression and fatigue in stable kidney transplant recipients.

METHODS:This single-centre cross-sectional study enrolled 128 stable kidney transplant patients at least 12 months post transplantation [mean age = 50 ± 15 years; 56% male; median time post-transplantation = 5 (2-11) years]. Depression and fatigue were assessed with the hospital anxiety and depression scale (HADS) and the multidimensional fatigue inventory-20 (MFI-20) respectively. Fasting blood sample was taken for the analysis of highly sensitive C-reactive protein (hsCRP).

RESULTS:The average level ofhsCRP was 3.95 mg/L (range 0.90 – 34.68). hsCRP predicted individual differences in depressive symptoms (R=0.32, p0.01) as well as the fatigue dimensions of ‘reduced activity’ and ‘physical fatigue’ (R>0.30, p0.01, all analyses adjusted for age, ethnicity, BMI and gender). In patients with clinical levels of depressive symptoms (HADS>8), the mean level of hsCRP was 7.85 mg/L versus 3.63 mg/L in non-depressed patients (p0.01). Further statistical adjustments for co-morbidity (Index of Coexistent Disease), estimated glomerular filtration rate and haemoglobin levels did not attenuate any of the observed associations.

CONCLUSION: In stable kidney transplant patients, inflammatory activity is an independent predictor of depressive symptom levels and lethargy, both important patient-reported outcome measures.Control of inflammation may contribute to improved well-being and activity levels in these patients.