Inspired by Yu et al 2025.[1]
This island is at the top of Poyang Lake, approximately 7km below where it opens into the Yangtze River just east of Jiujiang.
IF – impact factor
HAM-D – Hamilton depression rating scale
WHOQOL-100 – World Health Organisation quality of life 100
MCID – minimum important clinical difference– key to acronyms
The paper I am highlighting this week came out at the beginning of the year and has been sitting in my recent folder on Zotero for just over 4 months. It is a sham controlled parallel arm trial (n=64) of manual acupuncture for symptoms of depression in patients undergoing haemodialysis.
The paper is published in Acta Psychologica (IF 2.1). This journal was established in 1935 and became fully open access in 2021.
The authors all appear to come from Nanchang, Jiangxi province, which is in southeast China. Nanchang is the capital of Jiangxi and located in the north-central part of the province in the Poyang Lake Plain. The Poyang Lake is the largest freshwater lake in China and is visible from space. The lake is around 3500 square kilometres and is a winter home for Siberian cranes along with many other migratory birds.
The trial was run at 5 medical centres, which means that there were only about 12 patients on average in each centre.
The HAM-D was used as the primary outcome, but also used to determine inclusion. The HAM-D score had to be between 10 and 23. Above 23 would be categorised as very severe depression. The baseline average was 17.5, which indicates that the majority of patients would be in the mild to moderate depression categories. None were taking antidepressant medication, probably because of issues related to inadequate drug elimination in patients who need regular haemodialysis.
Secondary outcomes included a quality of life measure (WHOQOL-100) as well as biochemical parameters (serum albumin, haemoglobin, transferrin, total protein).
The acupuncture intervention was either real acupuncture needles inserted through adhesive gel pads or a non-penetrating sham using blunt needles inserted into the gel pads. The points used included LI4, LR3, ST36, and SP6. Manual stimulation was used to produce the typical needling sensation. Sessions lasted 20 minutes and were performed 3 times a week for 12 weeks making a total of 36 treatment sessions.
Needling through a pad of gel or foam is quite popular in China to facilitate use of a non-penetrating sham. A foam cube was first used in Germany around the turn of the millenium,[2] but it did not take off as a sham technique in the west. Some 20 years later it appeared again in China. Of course, China did not start doing sham controlled trials of acupuncture until about 2017.[3] In general, the non-penetrating sham techniques using blunt needles do tend to convince the subjects that they are getting real acupuncture, although in this paper there was no test of blinding performed.
The MCID on the HAM-D is often taken to be 3, but the literature varies, and some propose a range of 2 to 5. The data presented in this paper suggests there was a clinically meaningful improvement in both groups, which I guess is understandable if you consider the degree of individual attention provided by 36 treatments even if there was no needle penetration in one group.
There is some discrepancy between the change values quoted in one table and the baseline and final values quoted in other tables. It is possible that the change values were adjusted, but the difference looks too big to me, so I suspect errors in reporting.
The authors report final measures for the blood parameters, which are all significantly better in the acupuncture group. I like to see the baseline data to check that the groups both started from roughly the same levels, but that data isn’t provided. A multivariable regression analysis, using real acupuncture and the 4 different blood parameters as independent variables and the change in HAM-D as the dependant variable, showed that the change in HAM-D was strongly predicted by acupuncture (ie getting real penetrating acupuncture) and modestly predicted by the change in albumin levels, but not by the changes in the other blood parameters.
The changes in albumin, of course, are likely to be linked to the effect of acupuncture, so these cannot really be considered as independent variables. However, the advantage of adding this analysis is that it gives us some confidence that the data from changes in an entirely objective outcome measure appears to be congruent with the measured reduction in depression in the patients.
References
1 Yu X, Hua S, Jin E, et al. Improving hemodialysis patient depression outcomes with acupuncture: A randomized controlled trial. Acta Psychol (Amst). 2025;253:104728. doi: 10.1016/j.actpsy.2025.104728
2 Karst M, Rollnik JD, Fink M, et al. Pressure pain threshold and needle acupuncture in chronic tension-type headache–a double-blind placebo-controlled study. Pain. 2000;88:199–203.
3 Liu Z, Liu Y, Xu H, et al. Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence: A Randomized Clinical Trial. JAMA. 2017;317:2493–501. doi: 10.1001/jama.2017.7220
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