Associations of malnutrition and functional impairment with psychological distress among hemodialysis patients

Patients undergoing hemodialysis face both biological and psychological challenges, including dietary restrictions, functional limitations, and fear of death, which contribute to significant psychological distress. Despite the high burden of these stressors, psychosocial issues in this population remain underexplored. Given the limited effectiveness of pharmacological treatments, nonpharmacological approaches are crucial. This study aimed to investigate the impact of malnutrition and functional status on depression and anxiety among hemodialysis patients, with a focus on modifiable risk factors. This cross-sectional study measured depressive symptoms via the Patient Health Questionnaire (PHQ-9), anxiety levels via the Generalized Anxiety Disorder Scale (GAD-7), malnutrition status via the Malnutrition-Inflammation Score (MIS), and functional ability via the 5-point modified Rankin Scale (mRS). A multivariable linear regression analysis was used to examine factors influencing psychological health. This study involved 203 hemodialysis patients, 65% of whom were men, with an average age of 57.3 ± 14 years. Depression was reported by 41.9% of the participants, and anxiety was reported by 32%. According to the multilinear regression model, malnourished patients (unstandardized coefficient B, 0.409; 95% confidence interval (CI), 0.224–0.594; p < 0.001) and bedridden patients (unstandardized coefficient B, 3.192; 95% CI, 1.006–5.379; p < 0.001) were significantly associated with higher depression scores. Additionally, malnourished patients (unstandardized coefficient B, 0.290; 95% CI, 0.125–0.454; p < 0.001) and bedridden patients (unstandardized coefficient B, 2.206; 95% CI, 0.266–4.145; p = 0.017) were significantly associated with higher anxiety scores. According to the findings of this study, improved patient functional and nutritional health is linked to a decreased risk of anxiety and depression. Effectively screening hemodialysis patients for malnutrition risk factors while evaluating their functional level is crucial. This method can aid in promoting early adjustments and halting additional psychological distress.