TY - JOUR
T1 - Tryptophan and Kynurenine Levels and Its Association With Sleep, Nonphysical Fatigue, and Depression in Chronic Hemodialysis Patients
AU - Malhotra, Rakesh
AU - Persic, Vanja
AU - Zhang, Weifang
AU - Brown, Jill
AU - Tao, Xia
AU - Rosales, Laura
AU - Thijssen, Stephan
AU - Finkelstein, Fredric O.
AU - Unruh, Mark L.
AU - Ikizler, Alp
AU - Garimella, Pranav S.
AU - Ix, Joachim H.
AU - Kooman, Jeroen
AU - Levin, Nathan W.
AU - Handelman, Garry J.
AU - Kotanko, Peter
PY - 2017/7
Y1 - 2017/7
N2 - Objective: Sleep and mood disorders are common in hemodialysis (HD) patients and the pathophysiology is still unclear. Tryptophan (TRP) and its metabolites may play a prominent role in neural pathways related to sleep, fatigue, and depression. Here, we sought to compare the levels of TRP and its metabolites between HD patients and healthy subjects and examine their association with sleep, fatigue, and depression in HD patients. The design was cross-sectional analysis. Subjects: Ninety-nine adult patients on stable thrice weekly HD schedule between September 2011 and March 2014 and 10 healthy controls.Intervention: Venous blood samples were drawn in healthy subjects and immediately before dialysis in chronic HD patients. TRP and kynurenine (KYN) metabolites were measured by high-performance liquid chromatography. The Medical Outcomes Study Sleep Scale, the PROMIS Short form Fatigue, and the Patient Health Questionnaire were administered concurrently.Main Outcome Measure: Sleep, fatigue, and depression as assessed by subjective questionnaire.Results: TRP levels were significantly lower (52.4 +/- 15.2 vs. 67.9 +/- 3.1 mu mmol/L; PConclusions: Our study indicates disturbed TRP metabolism in HD patients, but low TRP levels were not related with sleep disturbances, depression, and fatigue. In contrast, KYN levels, a metabolite of TRP, were much higher in HD patients compared with controls, and higher KYN associated with depression and fatigue. Further studies exploring the biological and functional consequences of increased TRP catabolism in HD patients are warranted. (C) 2017 by the National Kidney Foundation, Inc. All rights reserved.
AB - Objective: Sleep and mood disorders are common in hemodialysis (HD) patients and the pathophysiology is still unclear. Tryptophan (TRP) and its metabolites may play a prominent role in neural pathways related to sleep, fatigue, and depression. Here, we sought to compare the levels of TRP and its metabolites between HD patients and healthy subjects and examine their association with sleep, fatigue, and depression in HD patients. The design was cross-sectional analysis. Subjects: Ninety-nine adult patients on stable thrice weekly HD schedule between September 2011 and March 2014 and 10 healthy controls.Intervention: Venous blood samples were drawn in healthy subjects and immediately before dialysis in chronic HD patients. TRP and kynurenine (KYN) metabolites were measured by high-performance liquid chromatography. The Medical Outcomes Study Sleep Scale, the PROMIS Short form Fatigue, and the Patient Health Questionnaire were administered concurrently.Main Outcome Measure: Sleep, fatigue, and depression as assessed by subjective questionnaire.Results: TRP levels were significantly lower (52.4 +/- 15.2 vs. 67.9 +/- 3.1 mu mmol/L; PConclusions: Our study indicates disturbed TRP metabolism in HD patients, but low TRP levels were not related with sleep disturbances, depression, and fatigue. In contrast, KYN levels, a metabolite of TRP, were much higher in HD patients compared with controls, and higher KYN associated with depression and fatigue. Further studies exploring the biological and functional consequences of increased TRP catabolism in HD patients are warranted. (C) 2017 by the National Kidney Foundation, Inc. All rights reserved.
KW - QUALITY-OF-LIFE
KW - CHRONIC KIDNEY-DISEASE
KW - CHRONIC-RENAL-FAILURE
KW - DIALYSIS PATIENTS
KW - MEDICAL OUTCOMES
KW - IMMUNE ACTIVATION
KW - DISORDERS
KW - SYMPTOMS
KW - VALIDITY
KW - CANCER
U2 - 10.1053/j.jrn.2017.01.024
DO - 10.1053/j.jrn.2017.01.024
M3 - Article
C2 - 28366444
SN - 1051-2276
VL - 27
SP - 260
EP - 266
JO - Journal of Renal Nutrition
JF - Journal of Renal Nutrition
IS - 4
ER -