Co-occurrence of Cognitive Dysfunction and Depressive Disorders in Hemodialysis Patients: Demographic Patterns and Unmet Diagnostic Needs

Cognitive impairment and depressive disorders are common yet under-recognized comorbidities among patients with chronic kidney disease (CKD) undergoing dialysis. Moreover, life orientation, ranging from optimism to pessimism, plays a substantive role in modulating both clinical and psychosocial outcomes. This pilot cross-sectional study, conducted in Lucknow, India, assessed cognitive function, psychological outlook, and depressive symptoms among patients undergoing hemodialysis using the Montreal Cognitive Assessment (MoCA), the Life Orientation Test-Revised (LOT-R), and the Patient Health Questionnaire-9 (PHQ-9). Results indicated that 41% had mild cognitive impairment (MCI) and 10% had moderate cognitive impairment. Depression was widely observed in the sample, with 58% of patients presenting moderate symptoms and 7% experiencing moderately severe depressive levels. A pessimistic life orientation was reported by 32% of participants, while only 6% demonstrated strong optimism. Individuals aged 46-60 years and male patients showed a disproportionately higher level of cognitive and psychological difficulties. Additionally, comorbid diabetes (53%) and hypertension (67%) were significantly linked to adverse clinical and psychosocial outcomes. These findings align with global literature reporting a cognitive impairment prevalence of up to 80% in dialysis populations and high depression rates ranging from 13% to 76%. Despite their high prevalence, these conditions remain underdiagnosed in nephrology practice. The study underscores the need for routine cognitive and psychological assessment in dialysis units and early psychosocial interventions and informs the design of larger multicenter studies. Integrating such care could improve patient adherence, safety, and overall quality of life among patients with CKD.