DEPRESSION AND ANXIETY IN ADULTS WITH STAGE 5 CHRONIC KIDNEY DISEASE RECEIVING RENAL REPLACEMENT THERAPY: A SYSTEMATIC REVIEW
TL;DR
The findings indicate a substantial burden of depressive and anxious symptoms among adults receiving RRT, although prevalence estimates should be interpreted in the context of methodological and clinical heterogeneity.
Abstract
Introduction: Adults with stage 5 chronic kidney disease (CKD) receiving renal replacement therapy (RRT) experience substantial physical and psychosocial burdens. Depression and anxiety may further affect daily functioning and health-related quality of life (HRQoL). However, estimates of psychological symptoms and their associated factors vary across populations, assessment instruments, and treatment modalities. This systematic review aimed to summarize the prevalence of depression and anxiety, identify reported associated factors, and examine their relationship with HRQoL among adults with stage 5 CKD receiving RRT. Methods: A systematic literature search was conducted in PubMed/MEDLINE, ScienceDirect, Taylor & Francis Online, and the Cochrane Library for studies published between January 2020 and December 2025. Eligible studies were observational investigations involving adults with stage 5 CKD or end-stage kidney disease receiving RRT and assessing depression and/or anxiety using validated instruments. Study selection, data extraction, and methodological appraisal were conducted according to predefined procedures. Findings were synthesized narratively because of heterogeneity in study designs, assessment instruments, and outcome definitions. Results: The original synthesis included ten studies, comprising diverse populations receiving hemodialysis, peritoneal dialysis, or kidney transplantation. Reported depression prevalence ranged from approximately 24% to 84.1%, while anxiety prevalence ranged from 23.1% to 86.0%; these estimates were not directly comparable because of differences in populations, instruments, and thresholds. Reported correlates included comorbidities, medication burden, nutritional and body-composition indicators, physical activity, sex, employment status, income, and dialysis-related characteristics. However, findings regarding several sociodemographic and treatment-related factors were inconsistent or derived from individual studies. Four studies assessed HRQoL using standardized instruments, providing limited evidence that psychological symptoms were associated with poorer quality of life, particularly in mental health domains. Discuss: The findings indicate a substantial burden of depressive and anxious symptoms among adults receiving RRT, although prevalence estimates should be interpreted in the context of methodological and clinical heterogeneity. Evidence concerning associated factors and HRQoL is less conclusive than the overall symptom burden, particularly because relatively few studies formally measured HRQoL and several findings were study-specific. Conclusion: Depression and anxiety warrant clinical attention in adults with advanced kidney disease receiving RRT. The available observational evidence supports consideration of systematic mental health assessment within kidney care, while further multicentre longitudinal studies are needed to clarify associated factors, temporal relationships, and the relationship between psychological symptoms and HRQoL.