December 27, 2019
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Inflammatory biomarker may predict whether patients with CKD will benefit from antidepressants

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Published findings determined that, for patients with chronic kidney disease and major depressive disorder, higher concentrations of the inflammatory biomarker hsCRP were associated with both improvement and response to the antidepressant sertraline.

“In the Chronic Kidney Disease Antidepressant Sertraline Trial (CAST), treatment with sertraline vs. placebo did not improve depressive symptoms in patients with CKD not requiring kidney replacement therapy and major depressive disorder,” L. Parker Gregg, MD, MSCS, of the University of Texas Southwestern Medical Center, and colleagues wrote in a research letter. “Patients with CKD have enhanced systemic inflammation, which has been proposed as a mediator of depression in chronic medical illnesses. It is unknown whether inflammatory biomarkers predict sertraline response in patients with CKD.”

To investigate whether baseline inflammatory biomarkers predicted a decrease in depressive symptoms in this population, researchers assigned 193 participants from the CAST study to either sertraline or placebo for 12 weeks. Biomarkers measured included plasma hsCRP, IL-6, albumin and pre-albumin. The clinician-scored quick inventory of depressive symptomatology (consisting of 16 items) was used to quantify depressive symptoms.

For patients taking sertraline, those who responded had higher hsCRP than non-responders. For those taking placebo, no associations between greater hsCRP and improvement or response were observed.

Researchers suggested that adding “clinically useful cutoffs of inflammatory biomarkers” and including all biomarkers improved prediction of sertraline response.

They concluded, “[A]mong individuals with CKD and [major depressive disorder] MDD, elevated plasma hsCRP independently predicted response to sertraline but not to placebo. Trials enrolling participants with CKD with elevated hsCRP may be more likely to identify a benefit of sertraline over placebo. Predictive models incorporating elevated hsCRP and low albumin and pre-albumin may be useful for identifying individuals more likely to benefit from sertraline.” – by Melissa J. Webb

Disclosures: Gregg reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.