Factors Contributing to the Depressive Symptoms Amongst Patients Receiving Hemodialysis

Background: Depression is the most prevalent psychiatric disorder among patients with end-stage renal disease (ESRD) receiving hemodialysis (HD), associated with reduced quality of life, poor treatment adherence, higher hospitalization rates, and increased mortality. This study evaluated associations between clinical and sociodemographic variables and depressive symptoms in HD patients. Methods: A cross-sectional study was conducted in a Portuguese HD center in November 2025. Adults (≥18 years) on HD for at least three months were eligible. Patients with cognitive impairment, communication difficulties, advanced malignancy, and acute debilitating illness were excluded. Sociodemographic, clinical and laboratory data were collected. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), with scores ≥10 defining clinically significant depressive symptoms. Associations were analyzed using bivariate methods and multivariate logistic regression. Results: A total of 174 patients were included (mean age 70,2 ± 13,7 years, 61,5% male). Clinically significant depressive symptoms were observed in 14 patients (8,0%). Female gender (OR=4,71; 95% CI: 1,10–20,11; p=0,037), higher Charlson Comorbidity Index (OR=1,38; 95% CI: 1,04–1,83; p=0,026), and anemia (OR=10,54; 95% CI: 2,44–45,62; p=0,002) were independently associated with depressive symptoms. Religious practice was inversely associated with depressive symptoms (OR=0,08; 95% CI: 0,02–0,35; p=0,001). No significant associations were found for other biochemical markers and sociodemographic factors. Conclusions: The prevalence of clinically significant depressive symptoms in this cohort was relatively low. Female gender, anemia, and high Charlson Comorbidity Index were independently associated with depressive symptoms, whereas engagement in religious practice was inversely associated. Systematic screening and integration of psychosocial and spiritual support into HD care may improve outcomes.