Key takeaways:
- Among patients on hemodialysis, 80% had minimal and 10.3% had moderate to severe depressive symptoms.
- Patients who initiated dialysis with a catheter had the greatest risks for moderate to severe depression.
NEW ORLEANS — Vascular access type and other factors may be associated with depression severity for patients on hemodialysis, according to data presented at the National Kidney Foundation Spring Clinical Meetings.
To evaluate depression severity among a cohort of patients on hemodialysis, Abdalmahmoud Alwali, MD, MPH, a nephrology fellow at Harlem Hospital Center in New York, and colleagues assessed 175 patients (57.7% men; 83.4% Black) who initiated dialysis through an arteriovenous fistula (68%), permanent catheter (24.6%) or arteriovenous graft (7.4%). Depression was assessed using the Patient Health Questionnaire-9 and categorized as no/minimal, mild, moderate and moderate to severe/severe.
Results showed that 80% of patients had minimal depression while 10.3% of patients had moderate to severe depression.
Notably, patients with permanent catheters reported significantly higher rates of moderate to severe depression compared with patients who had fistulas (25.6% vs. 5.9%). No patients with arteriovenous grafts reported moderate to severe depression.
Patients with permanent catheters also reported a higher median depression score compared with the other vascular access types (median score, 2; interquartile range [IQR] = 0-15 vs. median score, 1; IQR = 0-3).
Abdalmahmoud Alwali
“There may be several plausible mechanisms for why vascular access is linked to depression severity, though causation is not proven,” Alwali told Healio. “For example, catheter care imposes daily reminders of illness, such as dressing changes, shower limitations and swimming restrictions, that may reduce quality of life.”
Higher depression scores were significantly associated with several patient and laboratory factors, including higher parathyroid hormone, higher C-reactive protein and higher serum phosphate levels, lower ferritin levels and younger age, according to the researchers.
“I was surprised that dialysis and high phosphorus levels did not predict hospitalization,” Alwali said.
Overall, the researchers wrote, more depression screenings are needed in practice, particularly for patients with catheters.
“Clinicians need to focus on more than solely Kt/V and phosphorus binders,” Alwali said. “We need to start screening patients on catheter for depression and malnutrition — and treat those as aggressively as you treat anemia or bone disease.”
More research is needed to address study limitations, including a small sample size, and to help determine potential causal factors associated with depression, Alwali said. Interventional trials and mechanistic studies, as well as longitudinally tracking depression symptoms, could inform future research, he said.
For more information:
Abdalmahmoud Alwali, MD, MPH, can be reached at alwaliabdalmahmoud@gmail.com.
Sources/Disclosures
Source:
Alwali A, et al. Abstract LB-05. Presented at: NKF Spring Clinical Meetings; May 6-10, 2026; New Orleans.
Disclosures:
Alwali reports no relevant financial disclosures.
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