Epidemiological Data on Mental Health Among Patients with Chronic Kidney Disease (CKD)

Andrew Kowalski, MD, FASN

Introduction

CKD is a growing global public health issue, affecting an estimated 9–13% of the world’s population. As CKD progresses, it leads to a significant deterioration in quality of life due to physical limitations, complex treatment regimens, and comorbid conditions. Among these comorbidities, mental health disorders—particularly depression and anxiety—are increasingly recognized as highly prevalent yet underdiagnosed and undertreated conditions. Understanding the epidemiology of mental health disorders in CKD patients is essential for the development of comprehensive care models.

Prevalence of Mental Health Disorders in CKD

Depression

Depression is the most commonly reported psychiatric disorder among CKD patients. Numerous meta-analyses have shown that the prevalence of depression varies depending on the stage of CKD and the diagnostic tools used.

Among pre-dialysis CKD patients, the prevalence of depressive symptoms ranges from 20% to 30%.
In patients undergoing hemodialysis, the rates rise significantly, with 25–50% meeting criteria for depressive disorders.
Those on peritoneal dialysis report similar rates, although some studies suggest slightly lower prevalence compared to hemodialysis patients.

An important point needs to be addressed here, the method of assessment influences prevalence estimates. Studies using clinical interviews report lower rates than those using self-report scales, indicating potential overestimation by the latter due to somatic symptom overlap.

Anxiety

Anxiety disorders are also highly prevalent among CKD patients, although less frequently studied than depression.

20–40% of CKD patients exhibit clinically significant anxiety symptoms.
Anxiety is especially prevalent among younger patients, those with less social support, and those facing uncertainty about disease progression or transplantation.

Cognitive Impairment and Other Disorders

Cognitive dysfunction, adjustment disorders, and insomnia are also prevalent in CKD populations. Cognitive impairment, in particular, is found in up to 70% of patients with ESRD, impacting treatment adherence and quality of life. The etiology is multifactorial, involving uremic toxins, cerebrovascular disease, and chronic inflammation.

Risk Factors for Psychiatric Comorbidity in CKD

Several demographic, clinical, and psychosocial factors contribute to the high burden of mental illness among CKD patients:

Biological factors: Uremia, inflammation, and neuroendocrine dysregulation.
Psychosocial stressors: Financial hardship, job loss, social isolation, and lifestyle limitations.
Comorbidities: Diabetes, hypertension, and cardiovascular disease, which are not only common in CKD but also independently associated with depression and anxiety.
Treatment burden: Dialysis schedules, dietary restrictions, and polypharmacy.

Impact on Clinical Outcomes

Mental health disorders in CKD patients are associated with:

Poor adherence to dialysis and medication regimens.
Increased hospitalization and longer hospital stays.
Reduced quality of life across physical, psychological, and social domains.
Increased mortality risk, particularly with comorbid depression, which is linked to a 1.5–2.5 fold increase in mortality in dialysis patients.

Epidemiological Gaps and Challenges

Despite the growing body of evidence, there remain gaps in epidemiological data:

Underdiagnosis due to lack of routine screening in nephrology clinics. This is now slowly being addressed with the initiation of Value Based Care and the implementation of periodic screening in nephrology clinics, although this process is still in its infancy.
Variability in diagnostic criteria and tools across studies.
Limited data from low- and middle-income countries.
Lack of longitudinal studies tracking the progression of mental health conditions in CKD over time.

Conclusion

Mental health disorders are highly prevalent among CKD patients and significantly affect their clinical outcomes and quality of life. The epidemiological data underline the urgent need for integrated care approaches that include mental health screening, referral, and treatment within nephrology services. More standardized and globally representative studies are needed to better understand the burden and guide effective interventions.