Abstract
OBJECTIVE: B-cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL) are cytokines that play critical roles in the maturation, homeostasis, and differentiation of B-cells. Both cytokines have also been associated with mental disorders. The link between inflammation and depression is well-established. Patients undergoing hemodialysis who also experience depressive symptoms exhibit a state of immune dysfunction. We hypothesized that BAFF and APRIL levels would influence future depressive symptoms in hemodialysis patients. METHODS: We enrolled 72 hemodialysis patients without baseline depressive symptoms. Depressive symptoms were assessed annually for 2 years using the Beck Depression Inventory-II. The participants were measured for plasma BAFF, APRIL, and tumor necrosis factor-a levels. To evaluate the impact of these levels on the development of depressive symptoms, we performed Cox regression and Kaplan-Meier analysis. RESULTS: Depressive symptoms were observed in 31 (43.1%) patients. In both univariate and multivariate Cox regression analyses, a 1 SD increase in BAFF was significantly associated with an increased risk of future depressive symptoms, with hazard ratios of 1.44 (95%CI 1.03-2.00) and 1.70 (95%CI 1.04-2.78), respectively. Higher BAFF groups had a significantly greater incidence of depressive symptoms over 2 years (p = 0.048). CONCLUSION: Elevated plasma BAFF levels were significantly associated with the development of depressive symptoms in hemodialysis patients.