1,2*,4Dept. of Pharmacy Practice, KLE college of pharmacy, Belagavi, KLE Academy for higher education and research centre, Belagavi-590010, India.
3Dept. of Nephrology, KLEs Dr. Prabhakar Kore Hospital and Medical research centre, Belagavi-590010, India
Chronic kidney disease (CKD) significantly affects patients QoL through physical, psychological, and social challenges. This study aimed to examine the prevalence of anxiety and depression among CKD patients and explore their relationship with sociodemographic factors, such as age, education, and disease stage. A cross-sectional study was conducted at KLE’s Dr. Prabhakar Kore Charitable Hospital, Belagavi, including 106 CKD patients aged 18 and above. Data were collected through structured interviews using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales to assess anxiety and depression, and the WHOQOL-BREF questionnaire was used to measure QoL across four domains: physical, psychological, social, and environmental well-being. Statistical analysis was performed using SPSS v29, to examine QoL and various sociodemographic and disease-related factors. Results indicated that the majority of CKD patients were between 21-60 years old, with a notable number being self-employed males and housewives among females. Approximately 52.83% of participants were on dialysis, and a higher percentage were in Stage 2 CKD. Psychological distress was prevalent, with males exhibiting mild to moderate anxiety and depression, while females had a higher prevalence of severe depression. QoL scores were generally moderate to poor across all domains, reflecting the significant impact of CKD on both mental and physical well-being. conclusion the study emphasizes the need for integrated care that addresses both medical and psychological needs of CKD patients to improve their QoL. Further research is needed to develop strategies for long-term improvements in CKD patient care.
Chronic kidney disease (CKD) is a progressive condition where the kidneys gradually lose their functional capabilities, affecting a substantial segment of the global population. ¹ Beyond its physical toll, CKD is strongly associated with mental health challenges, particularly anxiety and depression. Despite their profound effect on quality of life and general well-being, these psychological concerns are frequently overlooked and left untreated in individuals with CKD.
Research conducted at Jordan University Hospital found that 58.3% of patients with CKD exhibited signs of depression, and 50.5% experienced symptoms of anxiety. These statistics underline the critical need for an integrated approach to care those addresses both physical ailments and mental health issues. Healthcare professionals must focus on supporting the overall well-being of CKD patients to promote better health outcomes and enhance their quality of life. ¹, ²
Several studies have examined anxiety and depression in CKD patients, often highlighting sociodemographic differences. Despite this, mental health remains an overlooked aspect of chronic disease care. Depression affects 22.8% to 39.3% of haemodialysis patients, with longer disease duration linked to higher depression rates. These findings emphasize the need to integrate mental health support into routine CKD care. ³
Validated assessment tools have been used across studies to evaluate the severity of anxiety and depression in CKD patients. The reported prevalence of anxiety varies widely, ranging from 28% to 71% across different studies. However, one particular study targeting haemodialysis patients noted a lower anxiety prevalence at 28%. Additionally, a systematic review and meta-analysis published in 2020 concluded that the pooled prevalence of anxiety disorders among CKD patients was 19%, whereas 43% of patients showed elevated anxiety symptoms. These findings stress the critical importance of recognizing and managing mental health issues within this patient population and call for continued research and intervention strategies. ?
CKD affects approximately 9.1% of the global population and contributes significantly to health complications such as cardiovascular disease, disturbances in electrolyte balance, and increased risk of death. Self-reported data indicate that 39.3% of individuals with CKD suffer from depression, substantially affecting their quality of life. ? Many studies have investigated the quality of life (QoL) in patients undergoing maintenance haemodialysis (MHD), often finding it to be lower than that of the general population or individuals with other chronic diseases.6
Chronic kidney disease (CKD), a progressive disease of the modern era, impairs physical health, limits daily activities, and leads to frequent hospitalizations. 7 In Nepal, where hospitals offer free haemodialysis, around 3 million CKD patients are treated, with or without dialysis. 8 CKD places a heavy strain on healthcare systems and is closely associated with hypertension and diabetes. Studies show that haemodialysis patients report poorer QoL compared to those on peritoneal dialysis or with kidney transplants, affecting both family income and national development. 7,8
QoL assessments in CKD often lack depth, with many small-scale studies providing limited information. 9 In India, CKD affects 17.2% of the population, with 6% at stage 3 or worse. ? Addressing mental health, social, and economic challenges, along with timely interventions, is crucial to improving Health-Related Quality of Life (HRQoL) and patient outcomes. ?
This study assessed the prevalence of anxiety and depression in CKD patients using standardized tools (GAD-7 and PHQ-9) and examined their association with various sociodemographic factors. It aimed to support integrated care strategies to improve patient outcomes and well-being. The study also compared anxiety and depression rates between dialysis and non-dialysis patients and used the WHOQOL-BREF to evaluate quality of life across physical, psychological, social, and environmental domains, along with overall QoL and general health.
MATERIALS AND METHODS
A cross-sectional observational study was conducted at KLEs Dr. Prabhakar Kore Charitable Hospital and Medical Research Centre in Belagavi, involving 106 chronic kidney disease (CKD) patients aged 18 years and older. The participants were interviewed using structured questionnaires, which included the WHOQOL-BREF to assess their quality of life (QoL) on a scale of 0–100, as well as the GAD-7 and PHQ-9 scales to evaluate their levels of anxiety and depression. In addition to this, sociodemographic data and clinical factors were also gathered. The data was analysed using SPSS version 29.
Ethical Clearance:
The research was conducted in accordance with the ethical guidelines outlined in the Declaration of Helsinki, spanning from September 2024 to March 2025. The study was approved under the registration number KLECOPBGMEC/D021-2024 (August 2024) and was also registered with CTRI under the number CTRI/2024/10/075616. Prior approval was obtained from the institutional human ethics committee, and informed consent was acquired from all participants involved in the study.
RESULTS AND DISCUSSION
The Table:1 provides a comprehensive breakdown of the demographic characteristics of 106 participants, categorized by Age Group, Education Level, Marital Status, Occupation, History of Smoking, History of Alcohol, and Domicile, with data separated by Gender (Male and Female). Majority of participants were from both the age groups of 41–60 and 61-80 years, each representing 39.62% of the sample. The Education Level shows that a significant portion of participants (30.19%) have completed senior secondary education, while 16.04% were illiterate.
Table no.1: socio-demographic profile of the participants n= (106)
|
Category |
Male |
Female |
FQ (%) |
|
Age Group |
|||
|
<20 years |
0 |
1 |
1 (0.95%) |
|
21– 40 years |
12 |
09 |
21(19.81%) |
|
41–60 years |
30 |
12 |
42(39.62%) |
|
61-80 years |
29 |
13 |
42(39.62%) |
|
Education Level |
|||
|
Illiterate |
6 |
11 |
17(16.04%) |
|
Primary |
6 |
8 |
14(13.21%) |
|
Secondary |
11 |
7 |
18(16.98%) |
|
Sr. Secondary |
27 |
5 |
32(30.19%) |
|
Graduate |
18 |
2 |
20(18.87%) |
|
Postgraduate |
3 |
2 |
5 (4.72%) |
|
Marital Status |
|||
|
Single |
9 |
2 |
11(10.38%) |
|
Married |
62 |
33 |
95(89.62%) |
|
Occupation |
|||
|
Unemployed |
3 |
0 |
3 (2.83%) |
|
Self-Employed |
43 |
5 |
48(45.28%) |
|
Farmer |
18 |
3 |
21(19.81%) |
|
Retired |
4 |
1 |
5 (4.72%) |
|
Housewife |
0 |
25 |
25(23.58%) |
|
Other |
3 |
1 |
4 (3.77%) |
|
History of Smoking |
|||
|
Current |
16 |
0 |
16(15.09%) |
|
Ex-Smoker |
40 |
2 |
42(39.62%) |
|
Never |
15 |
33 |
48(45.28%) |
|
History of Alcohol |
|||
|
Current |
17 |
1 |
18(16.98%) |
|
Ex-Alcoholic |
48 |
1 |
49(46.23%) |
|
Never |
6 |
33 |
39(36.79%) |
|
Domicile |
|||
|
Rural |
33 |
17 |
50(47.17%) |
|
Urban |
38 |
18 |
56(52.83%) |
|
Total |
71 |
35 |
106 |
When considering Marital Status, a vast majority of participants are married, accounting for 89.62% of the group, with only 10.38% being single. Regarding Occupation, most males are self-employed (60.56%), while a large proportion of females are housewives, representing 71.43% of the female participants. For History of Smoking, 56.34% of males are ex-smokers, while 94.29% of females have never smoked. In terms of History of Alcohol, a majority of males (67.61%) are ex-alcoholics, whereas most females (94.29%) have never consumed alcohol. Finally, Domicile is almost equally distributed between rural (47.17%) and urban (52.83%) areas, with males showing a higher percentage in rural areas and females in urban areas.
The Table 2 data show various health-related details of CKD patients. A total of 56 participants (52.83%) were on dialysis, with 42 males (39.62%) and 14 females (13.21%), while 50 participants (47.14%) were not on dialysis, consisting of 29 males (27.36%) and 21 females (19.81%). Among those on dialysis, 45 participants (42.45%) have been undergoing treatment for more than six months, with 32 males (30.19%) and 13 females (12.26%), while 15 participants (10.38%) have been on dialysis for less than six months. In terms of CKD diagnosis, 49 participants (46.23%) had CKD for 1 to 3 years, 30 participants (28.30%) for 3 to 5 years, 20 participants (18.87%) for less than one year, and 7 participants (6.60%) for more than five years.
Table No.2: Descriptive Clinical Profile Of Ckd Patients
|
Category |
Male |
Female |
Fq (%) |
|
On Dialysis |
42 |
14 |
56 (52.83%) |
|
Not on Dialysis |
29 |
21 |
50 (47.17%) |
|
Duration of Dialysis |
|||
|
> 6 Months |
32 |
13 |
45 (42.45%) |
|
< 6 Months |
8 |
3 |
15 (10.38%) |
|
Duration of CKD since Diagnosis |
|||
|
<1 Year |
12 |
8 |
20 (18.87%) |
|
1 - 3 Years |
32 |
17 |
49 (46.23%) |
|
3 - 5 Years |
22 |
8 |
30 (28.30%) |
|
>5 Years |
5 |
2 |
7 (6.60%) |
|
Stages of CKD |
|||
|
Stage 1 |
8 |
6 |
14 (13.21%) |
|
Stage 2 |
27 |
14 |
41 (38.68%) |
|
Stage 3a |
5 |
2 |
7 (6.60%) |
|
Stage 3b |
1 |
0 |
1 (0.94%) |
|
Stage 4 |
18 |
7 |
25 (23.58%) |
|
Stage 5 |
12 |
6 |
18 (16.98%) |
|
Any Comorbidities |
|||
|
Yes |
53 |
31 |
84 (79.25%) |
|
No |
18 |
4 |
22 (20.75%) |
|
Treatment for CKD |
|||
|
Haemodialysis |
36 |
12 |
48 (45.28%) |
|
Transplant |
1 |
1 |
2 (1.89%) |
|
P. Dialysis |
3 |
1 |
4 (3.77%) |
|
AKI |
15 |
8 |
23 (21.70%) |
|
None of the Above |
16 |
13 |
29 (27.36%) |
|
Number of Medications |
|||
|
More Than 5 |
57 |
28 |
85 (80.19%) |
|
Less Than 5 |
14 |
7 |
21 (19.81%) |
|
BMI Range |
|||
|
< 18.5 |
19 |
14 |
33 (31.13%) |
|
18.5 - 24.9 |
27 |
14 |
41 (38.68%) |
|
25 - 29.9 |
25 |
6 |
31 (29.25%) |
|
> 30 |
0 |
1 |
1 (0.94%) |
The stages of CKD among the participants are as follows: 14 participants (13.21%) were in Stage 1, 41 participants (38.68%) in Stage 2, 7 participants (6.60%) in Stage 3a, 1 participant (0.94%) was in Stage 3b, 25 participants (23.58%) were in Stage 4, and 18 participants (16.98%) in Stage 5. In terms of comorbidities, a total of 84 participants, representing 79.25% of the cohort, were found to have at least one comorbid condition. This group included 53 males (50%) and 31 females (29.25%). The majority of the participants were receiving haemodialysis treatment (45.28%), followed by 21.70% who were treated for Acute Kidney Injury (AKI), while 1.89% and 3.77% receiving kidney transplant and peritoneal dialysis, respectively. Additionally, 27.36% of participants had not received any of these treatments.
The majority of participants (80.19%) consumed more than five medications, while 19.81% were on less than five. In terms of Body Mass Index (BMI), the data reveals the following distribution among the participants: 41 individuals (38.68%) fall within the normal BMI range of 18.5 to 24.9, while 33 participants (31.13%) have a BMI of less than 18.5. Additionally, 31 participants (29.25%) fall into other BMI categories have a BMI between 25 and 29.9, and 1 female (0.94%) has a BMI greater than 30.
Table 3 Prevalence Of Anxiety And Depression Among Male And Female Patients
|
DEGREE |
ANXIETY MALE |
ANXIETY FEMALE |
DEPRESION MALE |
DEPRESION FEMALE |
|
No/Minimal |
29 |
16 |
29 |
13 |
|
Mild |
28 |
12 |
20 |
10 |
|
Moderate |
10 |
6 |
14 |
6 |
|
Severe |
4 |
1 |
8 |
6 |
|
Total |
71 |
35 |
71 |
35 |
In Table 3: The table summarizes the distribution of anxiety and depression levels among male and female patients. The data indicate a significant prevalence of anxiety and depression among the study participants. While 33.0% showed no or minimal anxiety symptoms, 14.2% reported mild anxiety, and a substantial 52.8% experienced moderate to severe anxiety demonstrating that more than half of the sample is notably affected.
In terms of depression, 39.6% had no or minimal symptoms, 28.3% experienced mild depression, and 32.1% reported moderate to severe depression. These results reflect a considerable mental health burden, with over half of the participants facing clinically relevant anxiety and nearly a third showing significant depressive symptoms.
Overall, Gender-wise, the prevalence varied markedly. Among male participants, 66.2% demonstrated varying levels of anxiety, while 59.2% exhibited symptoms of depression." In comparison, anxiety was even more pronounced among females, with 85.7% experiencing mild to severe anxiety and 62.9% presenting with depressive symptoms. These patterns emphasize a particularly high prevalence of anxiety among female participants. These findings indicate that while anxiety was slightly more prevalent among males, depression was more common and severe among females, underlining the importance of early psychological evaluation and tailored mental health interventions in both genders. The TABLE 4 provides insights into how various demographic factors influence anxiety and depression levels in the population. Age shows a clear trend, with younger individuals (under 20 years) reporting minimal anxiety and depression, while older age groups (21-60 years) experience higher levels of anxiety, especially mild and moderate forms. Those above 60 years have significant levels of moderate and severe anxiety and depression, Education level correlates with mental health, as illiterate individuals or those with only lower levels of education report experiencing higher rates of anxiety and depression compared to their counterparts with higher educational attainment. This indicates that lower education is linked to more severe mental health issues. Marital status also influences mental health, with married individuals reporting higher levels of anxiety and depression, particularly in the mild to moderate range. Single individuals generally show lower levels of mental health distress. In terms of occupation, self-employed people and farmers report higher levels of anxiety and depression, likely due to the stress associated with their work. In contrast, retired individuals and housewives tend to experience fewer mental health challenges. Smoking and alcohol consumption are associated with higher anxiety and depression levels.
Those who smoke or consume alcohol, especially current users, show higher mental health distress. Finally, individuals living in urban areas report slightly higher levels of anxiety and depression compared to those in rural areas, potentially due to the pressures of urban life.
Table 4: Demographic Factors Influencing Anxiety and Depression Levels in The Ckd Patients
|
Variables |
Male |
Female |
ANXIETY LEVELS |
DEPRESSION LEVELS |
||||||||
|
No/ Minimal |
Mild |
Moderate |
Severe |
Total |
No/ Mini mal |
Mild |
Moderate |
Severe |
Total |
|||
|
AGE GROUP |
||||||||||||
|
< 20 |
0 |
1 |
1 |
0 |
0 |
0 |
1 |
0 |
0 |
1 |
0 |
1 |
|
21–40 |
17 |
10 |
12 |
11 |
3 |
1 |
27 |
10 |
5 |
3 |
21 |
|
|
41–60 |
30 |
12 |
17 |
15 |
7 |
2 |
41 |
22 |
17 |
6 |
7 |
42 |
|
61-80 |
29 |
13 |
15 |
14 |
6 |
2 |
37 |
10 |
10 |
8 |
6 |
34 |
|
EDUCATION LEVEL |
||||||||||||
|
Illiterate |
6 |
11 |
4 |
9 |
3 |
1 |
17 |
5 |
6 |
2 |
4 |
17 |
|
Primary |
6 |
8 |
6 |
6 |
1 |
1 |
14 |
3 |
3 |
4 |
2 |
14 |
|
Secondary |
11 |
7 |
7 |
9 |
2 |
0 |
18 |
10 |
3 |
4 |
1 |
18 |
|
Sr. Secondary |
27 |
5 |
20 |
5 |
6 |
1 |
32 |
12 |
11 |
7 |
2 |
32 |
|
Graduate |
18 |
2 |
7 |
8 |
3 |
2 |
20 |
10 |
4 |
2 |
4 |
20 |
|
Postgraduate |
3 |
2 |
1 |
3 |
1 |
0 |
5 |
1 |
2 |
1 |
1 |
5 |
|
MARITAL STATUS |
||||||||||||
|
Single |
9 |
2 |
5 |
4 |
1 |
1 |
11 |
14 |
4 |
2 |
3 |
23 |
|
Married |
62 |
33 |
40 |
36 |
15 |
4 |
95 |
28 |
26 |
18 |
11 |
83 |
|
OCCUPATION |
||||||||||||
|
Unemployed |
3 |
0 |
0 |
1 |
2 |
0 |
3 |
0 |
3 |
0 |
0 |
3 |
|
Self employed |
43 |
5 |
19 |
20 |
6 |
3 |
48 |
22 |
13 |
7 |
6 |
48 |
|
Farmer |
18 |
3 |
11 |
8 |
1 |
1 |
21 |
9 |
5 |
7 |
0 |
21 |
|
Retired |
4 |
1 |
3 |
1 |
1 |
0 |
5 |
2 |
1 |
1 |
1 |
5 |
|
Housewife |
0 |
25 |
9 |
7 |
3 |
6 |
25 |
9 |
7 |
3 |
6 |
25 |
|
Others |
3 |
1 |
0 |
1 |
0 |
0 |
1 |
0 |
1 |
2 |
1 |
4 |
|
SMOKING HISTORY |
||||||||||||
|
Current |
16 |
0 |
5 |
6 |
2 |
3 |
16 |
5 |
4 |
4 |
3 |
16 |
|
Ex-smoker |
40 |
2 |
22 |
15 |
5 |
0 |
42 |
18 |
10 |
10 |
4 |
42 |
|
Never |
15 |
33 |
19 |
16 |
6 |
7 |
48 |
19 |
16 |
6 |
7 |
48 |
|
ALCOHOL HISTORY |
||||||||||||
|
Current |
17 |
1 |
8 |
5 |
3 |
2 |
18 |
8 |
2 |
5 |
3 |
18 |
|
Ex-alcoholic |
48 |
1 |
21 |
21 |
5 |
2 |
49 |
19 |
16 |
10 |
4 |
49 |
|
Never |
6 |
33 |
16 |
14 |
8 |
1 |
39 |
15 |
12 |
5 |
7 |
39 |
|
DOMICILE |
||||||||||||
|
Rural |
33 |
17 |
21 |
19 |
6 |
4 |
50 |
18 |
17 |
9 |
6 |
50 |
|
Urban |
38 |
18 |
24 |
21 |
10 |
1 |
56 |
24 |
13 |
11 |
8 |
56 |
|
Total |
71 |
35 |
45 |
40 |
16 |
5 |
106 |
42 |
30 |
20 |
14 |
106 |
In Table 5: In this study, among 106 CKD patients across all domains, the quality of life (QoL) was evaluated among patients with chronic kidney disease (CKD). Majority reported experiencing moderate to poor outcomes across all four assessed domains: physical health, psychological well-being, social relationships, and environmental factors. In the physical health domain, 41.5% of participants rated their condition as moderate, indicating some limitations but still maintaining partial functionality. Meanwhile, a significant portion reported poorer outcomes, with 27.4% describing their physical health as poor and 21.7% as very poor, suggesting widespread issues with mobility, energy levels, and ability to perform daily activities. Only a small minority, about 9.4%, considered their physical health to be good or very good. Regarding psychological well-being, 45.3% of patients reported moderate psychological health, reflecting struggles with emotional resilience, mood stability, and coping mechanisms. Alarmingly, nearly 44.3% experienced poor or very poor psychological states, pointing to considerable levels of depression, anxiety, or emotional distress within the CKD population. Only about 10.3% of patients rated their psychological health as good or very good, emphasizing a major mental health burden in this group. In terms of social relationships, which include personal relationships, social support, and interaction opportunities, 43.4% of participants assessed their situation as moderate. However, 30.2% reported poor social lives, and 13.2% felt their social support was very poor, suggesting that CKD may lead to social isolation, withdrawal from social activities, and weakened interpersonal connections. Only 13.2% rated their social relationships as good or very good, highlighting a general lack of strong support networks among patients.
When examining the environmental domain, which covers factors like living conditions, financial resources, access to healthcare, and safety, 37.7% of participants rated their environment as moderate. Yet, a concerning 35.8% found their environment poor, and 11.3% rated it as very poor, indicating significant dissatisfaction with their surroundings and resource accessibility. Only about 15.1% rated their environmental conditions as good or very good.
Table 5: Quality Of Life (Qol) Scores Across the Four Domains
|
QOL Category |
PHYSICAL SCORE |
PHYSIOLOGICAL SCORE |
SOCIAL SCORE |
ENVIRONMENTAL SCORE |
||||
|
Fq |
% |
Fq |
% |
Fq |
% |
Fq |
% |
|
|
Very Poor |
23 |
21.70% |
16 |
15.10% |
14 |
13.20% |
12 |
11.30% |
|
Poor |
29 |
27.40% |
31 |
29.20% |
32 |
30.20% |
38 |
35.80% |
|
Moderate |
44 |
41.50% |
48 |
45.30% |
46 |
43.40% |
40 |
37.70% |
|
Good |
8 |
7.50% |
10 |
9.40% |
13 |
12.30% |
15 |
14.20% |
|
Very Good |
2 |
1.90% |
1 |
0.90% |
1 |
0.90% |
1 |
0.90% |
|
Total |
106 |
100% |
106 |
100% |
106 |
100% |
106 |
100% |
DISCUSSION
A review of mental health outcomes among individuals with chronic kidney disease (CKD) shows notable differences in the prevalence of depression and anxiety across various populations. Mental health outcomes in chronic kidney disease (CKD) patients vary significantly, with high depression rates reported. One study found 93.4% of patients were depressed, categorized as mild (25.4%), moderate (47.2%), and severe (20.8%).2,11,12 This is notably higher than the 48% mild depression rate observed in another PHQ-9-based study.13 Severe depression was also seen in 45.3% of haemodialysis patients, linking disease progression to mental health deterioration. ? The present study found that, CKD patients not on dialysis showed lower anxiety and depression levels, with 42.0% reporting minimal or no depression and 56.0% minimal or no anxiety. Among dialysis patients, only 25.0% reported minimal or no depression, and 30.4% minimal or no anxiety. A significant 73.6% of patients diagnosed with chronic kidney disease (CKD) reported experiencing symptoms indicative of depression. Among these individuals, 6.6% exhibited minimal depressive symptoms, 25.5% reported mild symptoms, 47.2% experienced moderate symptoms, and 20.8% suffered from severe depression. These findings are consistent with previous research, which indicated that 93.4% of CKD patients reported depressive symptoms, with 45.3% experiencing severe depression.14,15
Research on gender and marital status effects varies; some studies noted higher depression and anxiety in women, ³ while others found no significant differences. ?, ? Differences may reflect sample composition, as some cohorts were predominantly male (67%).13 In our sample (67% men), depression was slightly more common in women (48.1%) than men (39.6%), but gender differences were minor. Marital status consistently affected outcomes, with unmarried individuals reporting higher anxiety and depression.2,5 Similarly, our study found a 10.4% severe anxiety rate among unmarried participants. Education and fewer medications were protective for mental health, as supported by previous studies.15,17
Haemodialysis was identified as a major factor contributing to depression and anxiety among CKD patients. While one study found no association between haemodialysis duration and mental health, ? another reported a 45.3% depression rate among haemodialysis patients.18 My research showed a 52.8% depression prevalence in haemodialysis patients, with more moderate to severe cases compared to non-dialysis patients, emphasizing the need for integrated physical and psychological care. ¹9
Lifestyle factors also played a role; alcohol use (17%) and smoking (15.1%) were linked to worsened mental health, consistent with earlier findings. 5, 15,18 My study confirmed these trends, with 17% of participants consuming alcohol and 15.1% smoking, reinforcing the impact of poor self-care on depression and anxiety.
These results highlight the complex influences on mental health in CKD, including comorbidities, age, gender, treatment type, and lifestyle. Non-dialysis patients reported better mental health, with 42.0% experiencing minimal or no depression and 56.0% minimal or no anxiety, versus 25.0% and 30.4% among dialysis patients, respectively.16
Our findings also revealed that 60.4% of haemodialysis patients exhibited depressive symptoms, with women (48.1%) reporting higher rates than men (39.6%). This contrasts with a 2020 Saudi Arabian study that reported 24.6% depression and 19.7% anxiety rates, both studies indicated a correlation between increasing age and higher levels of depression, as well as a greater prevalence of anxiety among women.20
Dialysis patients in present study had significantly lower physical functioning scores, supporting prior findings that dialysis adversely affects multiple QoL areas, including mobility, self-care, and mental health. 7 Most dialysis patients fell into "poor" or "very poor" QoL categories. Impact of Comorbidities such as diabetes (61.9%) and hypertension (56.2%) were common and associated with lower physical and psychological well-being, mirroring findings by Cruz et al.22 Higher education levels correlated with better QoL, likely due to greater health literacy. Women reported worse QoL than men, reflecting higher pain and anxiety levels, and married individuals demonstrated better QoL, highlighting the importance of social support. Effects on Work, Sleep, and Cognitive Function as CKD progressed, a decline in Health-Related Quality of Life (HRQoL) was noted (p = 0.005), affecting work status, sleep, cognitive ability, and social interaction, consistent with previous studies.10 Both studies emphasize CKD’s broad impact on patients' physical, mental, and social health, calling for targeted interventions.
In Sociodemographic and Comorbidity Pattern Our findings showed dialysis patients were slightly older (51.6 vs. 48.29 years) but had similar education levels compared to non-dialysis patients. Interestingly, more dialysis patients were employed (68.2% vs. 50.9%) despite worse health outcomes. However, the dialysis group carried a greater comorbidity burden and lower QoL.23
Together, these findings highlight the importance of adopting a comprehensive care model that combines medical treatment, psychological support, and social interventions to enhance patient well-being. Both our study and existing research emphasize that CKD has a profound negative impact on quality of life by affecting physical health, mental wellness, and social functioning. 24 These results strongly support the implementation of a holistic care strategy to better address the diverse needs of CKD patients and improve their overall outcomes.
CONCLUSION
Mental health assessment should be a core component of CKD care, with early intervention for anxiety and depression shown to improve patient outcomes and quality of life. This study highlights the significant impact of CKD on patients' physical, psychological, social, and environmental well-being, with many patients experiencing compromised health, emotional distress, social isolation, and poor living conditions. These findings stress the importance of a holistic care approach that combines medical treatment with psychological support, social services, and environmental improvements. Integrating these elements can better address the diverse challenges CKD patients face and improve their overall well-being. Future research is essential to develop effective mental health strategies in CKD management to further enhance patient outcomes.
ACKNOWLEDGMENTS
I would like to express my heartfelt gratitude to the participants of this study, who, despite their health challenges, kindly agreed to take part.
Conflict of interest: Corresponding author declares conflict of intrest as a member of ethics committee but is not part of the direct decision making process.
Financial support: None.
Ethics statement: The research was approved by the institutional ethics committee (KLECOPBGMEC/D021-2024)
REFERENCES
Harshavardhan, Geetanjali Salimath*, Mallikarjun Karishetti, Ifraa Warimani, Mental Health and Quality of Life Assessment in Chronic Kidney Disease: A Cross-Sectional Study, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 6, 1405-1416. https://doi.org/10.5281/zenodo.15613982
10.5281/zenodo.15613982
