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Abstract: TH-PO952

Depression and Anxiety Are Associated with Iron Deficiency Anemia for Patients with Stages 2-4 CKD

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Genc, Ilgin, Gazi Universitesi Tip Fakultesi, Ankara, Ankara, Turkey
  • Aksu, Muhammed Hakan, Gazi Universitesi Tip Fakultesi, Ankara, Ankara, Turkey
  • Yildirim, Saliha, Gazi Universitesi Tip Fakultesi, Ankara, Ankara, Turkey
  • Yasar, Emre, Gazi Universitesi Tip Fakultesi, Ankara, Ankara, Turkey
  • Helvaci, Ozant, Gazi Universitesi Tip Fakultesi, Ankara, Ankara, Turkey

Neuropsychiatric disorders, mainly cognitive decline, depression, and anxiety, are more common in CKD patients. The association between iron deficiency anemia (IDA) and cognitive decline is well-known for this population. For patients without CKD, IDA is associated with depression and anxiety. However, the link between depression, anxiety, and IDA is not clear in subjects with non-dialysis-dependent CKD. In this work, we aimed to evaluate the association above.


We selected a cohort of patients with stable stage 2-4 CKD and assessed them with Beck's depression inventory (BDI) and Beck's anxiety inventory (BAI). We excluded patients with acute kidney injury or decompensation, hematological/solid malignancies, and those suffering from psychological trauma. A diagnosis of schizophrenia, major depression, and bipolar disorder or using antidepressant/antipsychotic drugs were reasons for exclusion. We also did not include those needing EPO or those with other causes of anemia.


Two hundred patients were included in the final analysis. 76 of 200 (38%) patients were anemic. Patients with anemia were older and had worse GFR. BDI scores were worse for patients with anemia.
Furthermore, with a cut-off of eleven for BDI, 31,7% of patients in non-anemic and 51,4% of patients in anemic groups deserved further evaluation for clinical depression. The difference was significant (p=0,007). Univariate analysis did not reveal a relationship between BDI and hemoglobin, transferrin saturation, and ferritin levels. A multivariate analysis was not undertaken due to the low number of patients. A subgroup analysis of anemic patients also showed that patients who had received iron, despite being still anemic, had lower BDI scores compared to those with untreated anemia (p<0,001)

BAI scores were similar between groups. In addition, frequencies of minimal, mild, moderate, and severe anxiety were similar. However, in subgroup analysis, patients who had received iron despite being still anemic had lower BAI scores than those with untreated anemia.


Our work hints at a viable link between depression, anxiety, and IDA in subjects with Stage 2-4 CKD. However, this study is observational and thus only can generate a hypothesis. Prospectively designed studies on iron replacement may further elaborate our understanding of these associations.