Anxiety, Depression Linked to Poor Sleep Quality in ESRD Patients on HD

New research is shedding light on a significant association between anxiety, depression, chronic kidney disease (CKD) duration, and dialysis frequency with poorer sleep quality in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (MHD).1

Globally, ESRD affects more than 8.5 million individuals, with approximately 1 million new diagnoses each year. The disease impact, including high mortality and pain levels, places a significant economic and psychological burden on patients managing their symptoms. Furthermore, there is an increased prevalence of anxiety and depression among ESRD patients compared to the general population. Previous studies have linked impaired mental health with faster CKD disease progression.2

“By comprehensively examining the mental health and sleep quality of ESRD patients undergoing MHD, this study provides valuable insights for clinical practice,” wrote Jun Zhao, MM, at the Radiology Department at Third People’s Hospital of Hubei Province, Jianghan University, and colleagues. “The findings will contribute to optimizing patient management strategies, improving quality of life, and guiding the development of targeted psychological interventions. These results aim to enhance both the physical and mental well-being of ESRD patients while promoting better treatment outcomes.”

The retrospective cohort study systematically evaluated deidentified medical records of ESRD patients who underwent MHD in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture dialysis unit. Investigators aimed to assess the prevalence of anxiety, depression, and sleep disturbances and to further determine the independent relationships between anxiety, depression, dialysis frequency, and CKD duration on sleep quality.

Eligible patients were ≥18 years of age with an ESRD diagnosis and MHD treatment for ≥ 3 months, and completed records of clinical and psychological data; 70.77% underwent HD while the remainder underwent peritoneal dialysis. Average chronic kidney disease duration was 8.75 years (Standard Deviation [SD], 5.32), with a mean dialysis duration of 56.04 months (SD, 38.52) and an average dialysis frequency of 3.22 times per week (SD, 0.53).

A total of 65 patient records were assessed for anxiety, depression, and sleep quality, with assessments conducted 1 month after the completion of 3 months of dialysis. These factors were measured by the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and the Pittsburgh Sleep Quality Index (PSQI), respectively.

Subgroup analysis revealed greater rates of anxiety, depression, and poor sleep quality among patients with ESRD undergoing maintenance dialysis. Anxiety symptoms affected 55.38% of patients, while severe anxiety impacted 16.92%. Depression symptoms showed in 50.77% of patients, and severe depression in 20.00%. Sleep disorders were experienced by 72.30% of patients, with 15.38% classified as severe.

Using multiple linear regression, investigators assessed the independent effects of anxiety and depression on sleep quality, with PSQI scores as the dependent variable. Age, gender, and dialysis frequency were included as control variables. anxiety (Beta coefficient [β] = 1.253; P < .001) and depression (β = 1.125; P < .001) showed significant associations with poorer sleep quality. The 2 were not significantly related; their variance inflation factor was 1.478, confirming that multicollinearity was not a concern.

Investigators observed a stronger correlation between depression and sleep quality (correlation coefficient [R] = 0.63; P < .01) than anxiety (R = 0.56; P < .01). Disease-specific factors, including CKD duration (R = 0.45; P < .05), dialysis frequency (R = 0.38; P < .05), and serum creatinine levels (R = 0.34; P < .05), were also positively correlated with poorer sleep quality

Disease-specific factors, including CKD duration (β = 0.654; P = .002), dialysis frequency (β = 0.805; P = .002), and serum creatinine levels (β = 0.550; P = .002), were significantly associated with poorer sleep quality. In contrast, monthly household income showed a negative association with PSQI scores (β = −1.521; P < .001), indicating that patients with higher income levels experienced fewer sleep disturbances. Investigators pointed out there was no significant effect of age on sleep quality (P = .190).

“On a public health level, enhancing mental health support systems for ESRD patients – through psychological counseling services and mental health education programs – can effectively reduce the prevalence of anxiety and depression, thereby improving sleep quality,” concluded investigators. “Moreover, sleep hygiene practices and pharmacological interventions for sleep disorders should also be considered as part of the treatment plan. Comprehensive interventions should integrate psychotherapy (e.g., CBT), medication, and robust social support networks to promote holistic improvements in patient well-being.”

References

1. Du Z, Chu T, Dai F, Mao H, Zhao J. Correlation analysis of anxiety, depression, and sleep quality in end-stage renal disease patients undergoing maintenance hemodialysis. Medicine. 2025;104(42):e44433. https://doi.org/10.1097/MD.0000000000044433

2. Onishi Y, Uchida HA, Takeuchi H, et al. Impaired mental health status in patients with chronic kidney disease is associated with estimated glomerular filtration rate decline. Nephrology. 2018;24(9):926-932. https://doi.org/10.1111/nep.13515

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