Among 297 adults receiving maintenance haemodialysis in North and East London, moderate-to-severe depressive symptoms—defined by a Hamilton Depression Rating Scale score above 18—were associated with a 49% higher all-cause mortality risk (HR 1.49; 95% CI 1.00–2.23), though the association narrowly missed conventional statistical significance after full covariate adjustment (P=0.052). Higher white-cell count tracked with greater depressive severity before BMI adjustment, and diastolic blood pressure showed a sex-specific interaction with depressive symptoms. No inflammatory proteins or transcriptional markers significantly predicted depression severity in fully adjusted laboratory subset analyses.
End-stage kidney disease carries a depression prevalence roughly three to five times that of the general population, yet the mechanistic bridge between mood disorder and shortened survival remains poorly mapped. This prospective cohort adds nuance: the mortality signal exists but is fragile at the margin of significance, and the hypothesized immune-metabolic pathway—plausible given known links between renal failure, systemic inflammation, and depression—found little confirmatory support here. The sex-specific diastolic blood pressure finding is intriguing but hypothesis-generating only. Critical limitations include a modest sample (297 patients), a laboratory subset almost certainly smaller still, and the inability to establish causality from an observational design. This is a preprint posted on medRxiv and has not yet undergone peer review, meaning effect estimates and conclusions may shift. Overall, the work is incremental rather than paradigm-shifting, but it usefully flags depression as a clinically actionable risk marker warranting screening in dialysis care.
