Mental Health Disorders in End-Stage Kidney Disease: A Narrative Review of Clinical Considerations for Integrated Management.

introductionEnd stage kidney disease (ESKD) is associated with a high prevalence of depression and anxiety, arising from both biological factors and the psychosocial burden of chronic dialysis care. Approximately 25%-30% of dialysis patients experience clinically significant depressive symptoms when assessed by structured clinical interview, though reported prevalence varies widely by assessment method. These disorders negatively impact adherence, hospitalization rates, and mortality, with diagnostic challenges arising from overlapping uremic symptoms and reliance on self-report tools. Biological contributors such as uremia, anemia, chronic inflammation, and polypharmacy, together with social stressors including unemployment, isolation, and financial hardship, exacerbate psychiatric vulnerability. DISCUSSION: Randomized trials demonstrate that cognitive behavioral therapy (CBT) reduces depressive symptoms, improves quality of life, and enhances treatment adherence, and lessons from oncology and primary care support collaborative care models. However, dialysis centers often lack resources and are constrained by reimbursement policy. This narrative review synthesizes evidence across epidemiology, biopsychosocial mechanisms, pharmacotherapy considerations specific to renal impairment, and non-pharmacologic interventions, and proposes a roadmap for integrated mental health care in dialysis that clearly distinguishes evidence-based recommendations from expert opinion. Integrated, multidisciplinary approaches hold promise for enhancing patient well-being and reducing the burden of mental illness in dialysis care.