In end-stage kidney disease, inflammation, erythron abnormalities and declined kidney function tests are accompanied by increased affective symptoms, chronic-fatigue, and fibromyalgia

Abstract

Background. Numerous neuropsychiatric symptoms, including affective symptoms, chronic fatigue syndrome, and fibromyalgia symptoms, are present in patients with end-stage renal disease (ESRD). This study examines the relationship between neuropsychiatric symptoms and red blood cell (RBC) parameters, kidney function tests, zinc, C-reactive protein, and calcium levels in patients with ESRD. Methods. The above biomarkers and the Beck-Depression Inventory, the Hamilton Anxiety Rating Scale, and the Fibro-Fatigue Rating Scale were measured in 70 patients with end-stage renal disease (ESRD) and 46 healthy controls. Results. Increased scores of depressive, anxious, cognitive, and physiosomatic symptoms (including chronic fatigue, fibromyalgia, and autonomous symptoms) characterise ESRD. One latent vector could be extracted from these diverse symptom domains, which are, therefore, manifestations of a common core referred to as the physio-affective phenome. The combined effects of aberrations in red blood cells (RBC) (number of RBC, hematocrit, and haemoglobin), kidney function tests (glomerular filtration rate, ureum, creatinine, albumin, and total serum protein), C-reactive protein, zinc, and copper explained 85.0% of the variance in the physio-affective phenome. In addition, the effects of kidney function decline on the phenome were partially mediated by RBC aberrations and elevated copper, whereas the effects of dialysis frequency were entirely mediated by decreased zinc and elevated CRP. Conclusions. Affective (depression and anxiety), cognitive, and physiosomatic symptoms due to ESRD are interrelated manifestations of the physio-affective phenome, which is driven by (in descending order of importance) kidney dysfunctions, erythron deficits, inflammation, elevated copper, and decreased zinc.

In children with transfusion-dependent thalassemia, inflammation and neuronal damage biomarkers are associated with affective and chronic fatigue symptoms

“…Patients diagnosed with MDD and those experiencing affective and CFS symptoms because of end stage renal disease exhibit elevated levels of neuronal and astroglial projection markers (Al-Hakeim et al, 2023b, Al-Hakeim et al, 2023a). Cognitive function was found to be inversely correlated with increased NFL in patients with MDD (Bavato et al, 2021).…”

“…NFL levels are elevated not only in patients with MDD and bipolar disorder (Al-Hakeim et al, 2020, Chen et al, 2022) but also in those with treatment-resistant depression (Domingues et al, 2019, Spanier et al, 2019). Serum concentrations of NFL, nestin, CRP, and IL-10 are increased in patients with end-stage renal disease, while serum levels of zinc levels are reduced in comparison to the control group (Al-Hakeim et al, 2023b). NFL is a biomarker of neuronal injury and neurodegenerative processes in the central nervous system (CNS), whilst neurodegenerative diseases are frequently associated with elevated NFL plasma levels (Maes et al, 2022c, Yuan and Nixon, 2016).…”

Increased galanin-galanin receptor 1 signaling, inflammation, and insulin resistance are associated with affective symptoms and chronic fatigue syndrome due to Long COVID

“…The current findings support the idea that insulin resistance contributes to the affective and CFS of Long COVID. In addition, the study conducted by Al-Hakeim et al ( 2023) found a correlation between the onset of insulin resistance and the severity of inflammation during the acute phase of illness 94 . The authors of the study found that heightened insulin resistance plays a role in worsening and contributing to the immune-related neurotoxicity that leads to the physiological and emotional symptoms of Long COVID.…”