![]() There is now evidence that depression, anxiety, chronic fatigue, and physiosomatic symptoms are at least in part mediated through activated immune-inflammatory pathways, including increases in IL-6, IL-10, and CRP ( Maes and Carvalho, 2018, Maes et al., 2011b), lowered zinc ( Maes et al., 1994, Maes et al., 1997), and increased copper ( Ni et al., 2018). Previous studies showed a high incidence of chronic fatigue (42-89%) and depressive or/and anxiety symptoms (around 50%) in chronic renal disease ( Kim et al., 2012, Yoong et al., 2017)( Artom et al., 2014). ![]() In association with the biochemical changes, ESRD patients frequently experience physiosomatic symptoms, including chronic fatigue, fibromyalgia, muscular pain, insomnia, headache, cognitive impairments, and affective symptoms, including depression and anxiety ( Cohen and Kimmel, 2018, Savitha et al., 2020, Elzeiny and El-Emary, 2023, Ibrahim et al., 2023, Semaan et al., 2018, Qawaqzeh et al., 2023, Khoury et al., 2023, Burdelis and Cruz, 2023, Molfino et al., 2023, Asad et al., 2023). Malfunctions of electrolyte channels and transporters in the injured kidneys may cause abnormalities in sodium, potassium, chloride, and phosphate ( Kestenbaum et al., 2005, Einhorn et al., 2009, Barbour et al., 2008), and lowered serum calcium ( Timofte et al., 2021). ![]() Previous studies have demonstrated that acute ischemic kidney injury (AKI) may cause inflammatory responses in the peripheral blood ( Grigoryev et al., 2008). ![]() End-stage renal disease (ESRD) is accompanied by many biochemical changes, including alterations in immune-inflammatory mediators, such as C-reactive protein (CRP), interleukin (IL-6), and IL-10 ( Sinuani et al., 2013, Babaei et al., 2014, Oweis et al., 2021, Su et al., 2017), trace elements, including increased copper and lowered zinc, ( Almeida et al., 2020, Dizdar et al., 2020) and oxidative stress biomarkers ( Sangeetha Lakshmi et al., 2018, Song et al., 2020). ![]()
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