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Abstract: SA-PO457

Depression, Anxiety, and Stress – Before and After Dialysis Initiation: A Pilot Study

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 306 CKD: Cognitive Dysfunction, Depression, Quality of Life


  • Bezerra, Cicero I. L., Universidade de Sao Paulo, Sao Paulo, São PAULO, Brazil
  • Silva, Bruno C., Universidade de Sao Paulo, Sao Paulo, São PAULO, Brazil
  • Elias, Rosilene M., Universidade de Sao Paulo, Sao Paulo, São PAULO, Brazil

Chronic kidney disease (CKD) affects psychological and emotional aspects that are particularly critical while choosing the renal replacement therapy (RRT) modality. Anxiety, depression and stress are common yet frequently overlooked among these patients. We have examined the behavior of these emotional components pre- and post-RRT, and hypothesized that there will be an improvement of symptoms after starting dialysis, regardless of chosen modality.


This is a prospective observational study in which patients were approached in two moments: while attending the structured Pre-Dialysis Education Program, and after starting RRT (within the first 3 months). Scales of anxiety, depression and stress (Hospital Anxiety and Depression Scale and Perceived Stress Scale, respectively) were applied. Demographic and clinical characteristics were also assessed.


Out of 67 patients, 16 have already started RRT by April 2017 (50% men, age 56 ± 15 years, 58% Caucasian, 42% diabetic). Scores of depression, anxiety and stress reduced significantly from pre to post RRT initiation (Table 1), with no difference between patients who chose peritoneal dialysis or hemodialysis. Before RRT, anxiety scores correlated significantly with depression (r=0.75) and stress scores (r=0.79); after RRT initiation, anxiety scores correlated significantly with depression (r=0.59) and stress scores (r=0.62).


Although decision-making on RRT is a process associated with high scores of depression, anxiety and stress, these symptoms are attenuated at the end of this process, with patients already on dialysis. This finding identifies the importance of targeting psychological symptoms on RRT modality choosing process, and highlights that an improvement might occur after RRT initiation.

Table 1 - Anxiety, Depression and Stress scores before and after RRT initiation
 Before starting RRTAfter starting RRTp
Anxiety scores6.1 ± 3.31.9 ± 1.8
Depression scores7.8 ± 4.04.2 ± 2.8<0.0001
Stress scores29.4 ± 7.511.1 ± 6.4<0.0001