Yadav M, Kumar A, Pandey A, Singh S, Kumar R, Verma H, Mahajan S, Sharma S, Prasad P, Agarwal A. Depression in chronic kidney disease and dialysis: A psychonephrology narrative review. World J Nephrol 2026; 15(3): 121696 [DOI: 10.5527/wjn.121696]
Corresponding Author of This Article
Adarsh Kumar, DM, MD, Associate Professor, Department of Nephrology, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, Ansari Nagar West, Aurobindo Marg, Ring Road, New Delhi 110029, DL, India. adarshnephro081@gmail.com
Research Domain of This Article
Urology & Nephrology
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review-article
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Yadav M, Kumar A, Pandey A, Singh S, Kumar R, Verma H, Mahajan S, Sharma S, Prasad P, Agarwal A. Depression in chronic kidney disease and dialysis: A psychonephrology narrative review. World J Nephrol 2026; 15(3): 121696 [DOI: 10.5527/wjn.121696]
Monika Yadav, Adarsh Kumar, Rajesh Kumar, Himanshu Verma, Sanjiv Mahajan, Sourabh Sharma, Pallavi Prasad, Anupam Agarwal, Department of Nephrology, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi 110029, DL, India
Abhinav Pandey, Department of Psychiatry, T. S Mishra Medical College, Lucknow 226008, Uttar Pradesh, India
Swarndeep Singh, Department of Psychiatry, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi 110029, India
Co-first authors: Monika Yadav and Adarsh Kumar.
Author contributions: Yadav M and Kumar A conceptualized the study and prepared the initial draft of the manuscript and they contributed equally to this manuscript as co-first authors; Pandey A, Singh S, and Kumar R contributed to literature review and data interpretation; Verma H, Mahajan S, Sharma S, and Prasad P critically revised the manuscript for important intellectual content; Agarwal A supervised the study and provided overall guidance. All authors contributed to manuscript revision, read, and approved the final version of the manuscript.
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Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Adarsh Kumar, DM, MD, Associate Professor, Department of Nephrology, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, Ansari Nagar West, Aurobindo Marg, Ring Road, New Delhi 110029, DL, India. adarshnephro081@gmail.com
Received: March 31, 2026 Revised: May 22, 2026 Accepted: June 22, 2026 Published online: September 25, 2026 Processing time: 136 Days and 1 Hours
Abstract
Depression is one of the most prevalent yet under-recognized comorbidities in patients with chronic kidney disease (CKD), particularly among those receiving maintenance dialysis. Its presence adversely affects quality of life, treatment adherence, hospitalization rates, and survival, yet it frequently remains masked by overlapping somatic symptoms of uremia and chronic illness. Psychonephrology, an emerging interdisciplinary field, provides a framework to understand the complex bidirectional interactions between psychological health and kidney disease. This narrative review explores the epidemiology, pathophysiological mechanisms, clinical manifestations, and consequences of depression across the CKD spectrum, with a focus on patients undergoing hemodialysis and peritoneal dialysis. We discuss biological contributors including inflammation, neuroendocrine dysregulation, uremic toxin accumulation, and cerebrovascular changes, alongside psychosocial stressors such as illness chronicity, dependency, financial burden, and altered social roles. Challenges in screening and diagnosis, including the limitations of conventional depression scales in CKD populations, are highlighted. The review further examines the impact of depression on clinical outcomes, dialysis adequacy, nutritional status, and mortality. Finally, we summarize current evidence on pharmacological and non-pharmacological management strategies, emphasizing the role of integrated, multidisciplinary care models. Recognizing and addressing depression as a core component of CKD management is essential to improving holistic patient outcomes and advancing the practice of psychonephrology.
Core Tip: Depression is one of the most common yet under-recognized comorbidities in chronic kidney disease (CKD), especially among patients receiving maintenance dialysis. Overlapping somatic symptoms of uremia often complicate its diagnosis, leading to under detection and undertreatment. Beyond its profound impact on quality of life, depression is associated with poor treatment adherence, increased hospitalization, malnutrition, reduced dialysis adequacy, and higher mortality. Emerging evidence suggests that inflammation, neuroendocrine dysregulation, uremic toxin accumulation, and psychosocial stressors collectively contribute to its pathogenesis. This review highlights the epidemiology, mechanisms, diagnostic challenges, and clinical consequences of depression across the CKD spectrum, while emphasizing the evolving role of psychonephrology in integrating psychological and renal care. Early recognition and multidisciplinary management are essential to improving holistic outcomes in CKD patients.
