Depression in chronic kidney disease and dialysis: A psychonephrology narrative review

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.