Depression in chronic kidney disease and dialysis: A psychonephrology narrative review

doi:10.5527/wjn.121696

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World Journal of Nephrology

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2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Nephrol. Sep 25, 2026; 15(3): 121696
Published online Sep 25, 2026. doi: 10.5527/wjn.121696

Table 2 Enlist key uremic toxins and their effect on depression

Uremic toxins	Origin	Mechanism	Impact on brain
Indoxyl sulfate	Gut microbiota and liver	Activates aryl hydrocarbon receptor, increases BBB permeability	Reduce serotonin synthesis (approximately 40%), ↑ neuroinflammation (IL-6, TNF-α, NO)[46-48]
Kynurenines	Tryptophan kynurenine pathway	Modulate glutamatergic signaling, regulate inflammation	Imbalance in KA/QA ratio linked to severe depression[44]
p-cresyl sulfate	Phenylalanine metabolism	Poorly understood	May contribute to mood dysregulation[49]
4-ethylphenyl sulfate	Gut-derived phenol	Behavioral effects in mice	Possible link to anxiety and cognition[50]
Indole-3-propionic acid	Gut microbiota	Neuroprotective in some contexts	May improve social function (Janus-faced effect)[51]

BBB: Blood-brain barrier; IL-6: Interleukin-6; TNF-α: Tumor necrosis factor-α; NO: Nitric oxide; KA/QA: Kynurenic acid/quinolinic acid.

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Citation: Yadav M, Kumar A, Pandey A, Singh S, Kumar R, Verma H, Mahajan S, Sharma S, Prasad P, Agarwal A. Depression in chronic kidney disease and dialysis: A psychonephrology narrative review. World J Nephrol 2026; 15(3): 121696
URL: https://www.wjgnet.com/2220-6124/full/v15/i3/121696.htm
DOI: https://dx.doi.org/10.5527/wjn.121696

Yadav M, Kumar A, Pandey A, Singh S, Kumar R, Verma H, Mahajan S, Sharma S, Prasad P, Agarwal A. Depression in chronic kidney disease and dialysis: A psychonephrology narrative review. World J Nephrol 2026; 15(3): 121696 [PMID: 42626288 DOI: 10.5527/wjn.121696]

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