Kidney Week

Abstract: PUB066

Dry Weight and Serum Phosphate as Predictors of Major Depressive Disorder and Treatment Adherence in Patients on Hemodiafiltration

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Martinez, Itzel Anahi, Operadora de Hospitales Angeles SA de CV, Mexico City, CDMX, Mexico

Itzel Anahi Martinez, MD

• Sánchez de León Martínez, Jonathan, Operadora de Hospitales Angeles SA de CV, Mexico City, CDMX, Mexico

Jonathan Sánchez de León Martínez, MD

• Mendoza, Karen Monserrat, Operadora de Hospitales Angeles SA de CV, Mexico City, CDMX, Mexico

Karen Monserrat Mendoza, DrMed, MEd

• Montaño, Alejandro Rojas, Operadora de Hospitales Angeles SA de CV, Mexico City, CDMX, Mexico

Alejandro Rojas Montaño, MD

• Hernandez Flores, John, Operadora de Hospitales Angeles SA de CV, Mexico City, CDMX, Mexico

John Hernandez Flores, MD

• Morales Toc, Pedro David, Operadora de Hospitales Angeles SA de CV, Mexico City, CDMX, Mexico

Pedro David Morales Toc, MD

• Núñez Ramírez, Pablo Alexis, Operadora de Hospitales Angeles SA de CV, Mexico City, CDMX, Mexico

Pablo Alexis Núñez Ramírez, MD

• Secin, Ricardo, Operadora de Hospitales Angeles SA de CV, Mexico City, CDMX, Mexico

Ricardo Secin, JD

• Escalante, Karen, Operadora de Hospitales Angeles SA de CV, Mexico City, CDMX, Mexico

Karen Escalante, MS

• Delgado Avila, Brenda Guadalupe, Operadora de Hospitales Angeles SA de CV, Mexico City, CDMX, Mexico

Brenda Guadalupe Delgado Avila

Background

Major depressive disorder (MDD) is common in end-stage kidney disease (ESKD), but diagnosis in dialysis is complicated by overlap between depressive and uremic symptoms. Objective biochemical measures may provide a more reliable assesment of treatment adherence than patient self-report.

Methods

We conducted an analytical cross-sectional study of 17 adults receiving maintenance hemodiafiltration at a high-specialty dialysis unit in Mexico City. Depressive symptoms were screened with the Hospital Anxiety and Depression Scale (HADS), and MDD was confirmed through a structured psychiatric interview using DSM-5 criteria. Pharmacologic adherence was assessed with the 8-item Morisky Medication Adherence Scale, while objective adherence was evaluated using 3-month averages of serum phosphate, serum potassium, and interdialytic weight gain. Bioelectrical impedance analysis was used to assess dry weight, muscle mass, and phase angle. Bivariate analyses and multivariate logistic regression were performed to identify predictors of MDD and objective adherence.

Results

Depressive symptoms by HADS were present in 47.1% of patients, whereas DSM-5-confirmed MDD was identified in 29.4%, suggesting potential overestimation by screening alone. All patients with MDD were professionally inactive. MDD was significantly associated with lower muscle mass (p=0.012) and lower dry weight (p=0.0003). In multivariate analysis, dry weight was associated with lower odds of MDD (OR=0.780; 90% CI, 0.629–0.968; p=0.058). No significant association was found between MDD and self-reported medication adherence. Serum phosphate was the only significant objective predictor of adherence (OR=2.329; p=0.036).

Conclusion

In patients receiving hemodiafiltration, MDD was not directly associated with self-reported adherence, but was closely linked to nutritional and functional markers. Dry weight and muscle mass may serve as clinically useful somatic markers of depressive vulnerability, while serum phosphate may better identify objective nonadherence than patient self-report. These findings support integrating consultation-liaison psychiatry with renal care and incorporating nutritional and metabolic markers into mental health and adherence assessment.