الفهرس 
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Abstract
End stage renal disease (ESRD) represents a major public health problem. According to United State Renal Data System (USRDS) Registry, its incidence and prevalence is increasing over the last years.
ESRD patients are at increased risk for depression in comparison to the general population. This risk increases with deterioration of GFR and at the start of dialysis.
Depression in hemodialysis patients is an independent risk factor for hospitalization and mortality, not only because of the common risk factors such as cardiovascular events and infections.
The aim of this study was to assess the role of ADMA and BDNF in depression in ESRD patients on maintenance hemodialysis.
The study included 85 subjects, who were divided into 2 groups: 50 depressed (with HADS-D ≥ 8) ESRD patients on maintenance hemodialysis and 35 non-depressed (with HADS-D ≤7) ESRD patients on maintenance hemodialysis.
After obtaining an informed consent, the patients were subjected to history taking, clinical examination, laboratory investigations including routine laboratory investigations:- (CBC, urea before and after a mid-week session, creatinine, Ca, Ph., serum albumin, iPTH and uric acid as well as serum ADMA and BDNF levels). In addition, all subjects were subjected to HADS questionnaire, which was used as a mean for assessment of depression (cut off value for HADS-D ≥ 8).
group Ι included 50 patients, twenty were males and thirty were females with a mean age of (49.20 ± 12.27 years), while group ΙΙ included 35 patients, twenty three were males and twelve were females with a mean age of (46.0 ± 10.43 years).
There was a statistically significant difference between the two studied groups as regard the gender with a p value 0.02.
The study showed increased serum calcium, phosphorus, hemoglobin and URR in the depressed hemodialysis group (group I) in comparison to the non-depressed hemodialysis group (group II), while it showed decreased iPTH, albumin and uric acid in group I in comparison to group II.
The mean Hb level was significantly higher in group I (9.88 ± 1.06 g/dl) in comparison to group ΙΙ (9.25 ± 1.03g/dl) with a p value 0.007, while the mean serum albumin level was significantly lower in group I (3.79 ± 0.35 gm/dl) in comparison to group ΙΙ (3.97 ± 0.42 gm/dl) with a p value 0.039.
The mean BDNF level was significantly higher in group ΙΙ (9017.14 ± 4249.60 pg/ml) in comparison to group I (2556.0 ± 1498.15 pg/ml) with a p value <0.001.
Both the mean anxiety score and the mean depression score were significantly higher in group I (10.94 ± 4.44) and (13.10 ± 3.09) respectively in comparison to group ΙΙ (5.40 ± 3.84) and (3.31 ± 1.62) respectively with a p value < 0.001.
There was a statistically significant negative correlation between serum BDNF level and anxiety score and depression score in the total sample.
There was a statistically significant positive correlation between anxiety and depression score in group I, group II and total sample.
In our study, for BDNF, when a cut-off value of ≤ 4700 pg/ml was used, BDNF was a statistically significant predictor of depression with an AUC of 0.968, a specificity of 97.14% and a sensitivity of 88%.
In conclusion, serum albumin levels are lower in depressed hemodialysis patients hinting at the link between depression and malnutrition in hemodialysis patient. Also, BDNF may prove to be a useful marker of depression and anxiety in hemodialysis patients, while ADMA is not. More research is needed to examine the role of BDNF in the follow-up of the response to treatment in depressed hemodialysis patients.