TNF and chronic kidney disease: Systematic inflammation induced by a distressed mood may be another plausible explanation; many studies demonstrated that CKD patients with depressive symptoms had higher levels of circulating inflammatory markers, such as interlukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP), all of which play important roles in the pathogenesis of cardiovascular diseases and worsen the prognosis of CKD [5, 22].