Chronic Kidney Disease Paired With Social Frailty May Increase Depression Risk

In patients with chronic kidney disease (CKD), particularly those undergoing hemodialysis, social frailty might heighten depression, as suggested by a new study.1

These findings may underscore the future need for increased social support for patients with CKD undergoing dialysis or kidney transplant recipients to alleviate the increased levels of depression in the patient population.1

Social frailty in older adults can be indicated by certain factors, such as living alone, limited interpersonal support, interaction with neighbors, or a lack of community participation. The concept itself is still in its infancy, but “social frailty” has been defined as a progressive state of vulnerability to the loss or deprivation of resources necessary to fulfill one's basic social needs throughout life.2,3

Previous studies have linked social frailty to depression and, in turn, adverse health outcomes.3 In patients with CKD, adverse health outcomes might be exacerbated by social frailty, physical frailty, and mental health conditions.1

“The need for psychosocial support is particularly urgent in advanced stages of CKD, yet existing support systems are often inadequate,” wrote study investigator Fabiana de Souza Orlandi, PhD, an associate professor at the Federal University of São Carlos, and colleagues. “As a result, addressing psychosocial factors, such as social frailty, is crucial in managing these patients' health.”1

To address this gap in research, Orlandi and investigators conducted a cross-sectional, correlational, and comparative study to assess the prevalence and associated factors of social frailty in patients with CKD undergoing hemodialysis or kidney transplantation to examine its predictive role in the development of depressive symptoms.1

The investigators collected data using validated instruments. To assess social frailty, they used the HALFT Social Frailty Scale, which ranges from 0 to 5. Scores were categorized as: 0 (non-frail), 1–2 (pre-frail), and ≥ 3 (socially frail). Additionally, they utilized the Patient Health Questionnaire-9 (PHQ-9) to measure depression, and the Medical Outcomes Study Social Support Scale (MOS) to quantify social support.1

They used 2 multiple linear regression models to assess predictors of social frailty and depressive symptoms, adjusting for sociodemographic and clinical variables. They divided patients into 2 groups: those undergoing hemodialysis and kidney transplant recipients.1

Overall, the study included 284 adults ≥ 18 years of age with CKD from São Paulo, Brazil, of which 80 were undergoing hemodialysis, and 204 had undergone kidney transplantation > 1 month prior.1

Upon analysis, investigators found a statistically significant (P <.001) increased prevalence (51.2%) of social frailty in hemodialysis patients compared to kidney transplant recipients (24%), who had a larger proportion of non-frail individuals (24% vs 3.8%). In both groups, participants recorded depressive symptoms from mild to severe, with no statistically significant differences across symptom severity.1

In terms of social support, investigators reported significantly higher material support for hemodialysis patients (81.71 ± 24.19) compared to kidney transplant patients (38.83 ± 10.78; P < .001). Investigators also reported increased emotional support in hemodialysis patients (76.81 ± 25.11) compared to kidney transplant patients (73.40 ± 23.86), with a significant difference (P = .028).1

However, no significant differences were found in positive social interaction support, information support, and affective support between the groups (P = .293, .707, and .067, respectively).1

Upon multilinear analysis, kidney transplant recipients exhibited significantly decreased levels of social frailty, with a moderate negative effect (β = −0.60; P < .001). Additionally, investigators noted an association between increased levels of social support and decreased levels of frailty, demonstrating a moderate negative effect (β = −0.40; P < .001).1

Investigators noted the importance of no significant multicollinearity among variables as all variance inflation factors (VIFs) were below 2, except for income ≤ 1 minimum wage (VIF = 1.95).1

Upon analysis for depression, investigators found social frailty as the strongest predictor, with a moderate effect (β = 0.60; P < .001), indicating levels of increased social frailty were significantly associated with more severe depressive symptoms. The kidney transplant group was associated with decreased depression scores compared to the hemodialysis group, with a weak negative effect (β = −0.31; P = .012).1

“The findings of this study reinforce the importance of a multidimensional approach to the care of patients with CKD, extending beyond clinical interventions to include psychosocial support,” wrote investigators. “The identification of social frailty as a central predictor of depression highlights the need for continuous monitoring of this dimension and the implementation of strategies aimed at strengthening support networks, particularly among patients undergoing hemodialysis.”1

References

1. Gabriela D, Luma Geraigire, Ferreira S, et al. Predictors of Social Frailty and Depression in Brazilian Patients With Chronic Kidney Disease: A Cross‐Sectional Study. Geriatrics and gerontology international/Geriatrics & gerontology international. Published online January 1, 2026. doi:https://doi.org/10.1111/ggi.70317

2. Yamada M, Arai H. Understanding social frailty. Archives of Gerontology and Geriatrics. 2023;115:105123-105123. doi:https://doi.org/10.1016/j.archger.2023.105123

3. Graham J. Being “socially frail” comes with health risks for older adults. CNN. Published March 21, 2023. Accessed January 6, 2026. https://www.cnn.com/2023/03/21/health/navigating-aging-social-frailty-khn-partner-wellness

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