Chronic kidney disease (CKD) is a progressive condition characterized by a gradual decline in kidney function, classified into distinct stages based on the severity. Globally, CKD is an escalating health burden, ranking among the major causes of mortality. In Saudi Arabia, it is the third leading cause of death (1, 2). A notional laboratory-based study from 2015 to 2022 reported an overall CKD prevalence of 4.76%, with mostly stage 3 (3.5%) (3, 4). As kidney function deteriorates, patients often face complex physical, emotional, and social challenges, leading to increased risk of co-existing comorbid conditions, including diabetes mellitus and cardiovascular disease, which contribute to functional decline and negatively impact quality of life (QoL) (5, 6). While the physical consequences of CKD are well understood, the psychological aspect, particularly depression, remains underrecognized, especially among patients not yet receiving dialysis.

Depression is a prevalent mental health illness in CKD patients. A study conducted in 2022 confirmed that depression is more common among CKD patients, especially those experiencing end-stage renal disease (ESRD) (7). Furthermore, a Saudi-based study found that 24.6% of CKD patients undergoing hemodialysis had depression, with none receiving antidepressant treatment (8, 9). Despite this, limited attention has been given to depressive symptoms and QoL in non-dialysis CKD populations.

Quality of life is a multidimensional concept encompassing physical, emotional, and social well-being. It is profoundly affected by CKD progression. Depression has been shown to correlate strongly with reduced QoL, and both factors have been linked to poor clinical outcomes, including lower treatment adherence, increased hospitalization, and elevated mortality rates (10–12).

Recent evidence highlights the importance of assessing health-related quality of life (HRQoL) and using validated tools such as the Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms in chronic disease populations (13). These assessments provide critical insight into patient functioning and guide decision-making. CKD patients, especially those on dialysis, often report psychological and financial burden that further impacts their overall well-being. Enhancing patient education and integrating psychological support into CKD care can improve self-management and promote adherence to treatment plans (14).

While several studies have assessed depression and QoL in dialysis populations, the prevalence of depression and impact on health-related QoL remain underexplored in non-dialysis populations receiving conservative treatment for CKD (15). Divergent findings regarding the effects of age on QoL have been reported, with some studies negating its significance while others identifying age as the foremost determinant of QoL (16). Additionally, concerning related decision-making in the therapy plan for CKD, considering the choice of the better outcomes, in terms of the quality of life, survival percentage, and accompanying treatment options, between conservative therapy and dialysis (17), some studies have shown that conservative kidney management is a highly valuable replacement for traditional therapies for CKD patients (18). Six discriminations in CKD have also been investigated, with some studies finding that women have poorer outcomes than men (16).

Therefore, this study aimed to assess the prevalence of depression and evaluate its relationship with quality of life among non-dialysis CKD patients. By examining these outcomes across different CKD stages, we sought to better understand the psychological needs of this population and establish a supportive care plan that enhances patient quality of life and patient outcomes.

In this study, we aimed to assess the prevalence of depression and quality of life among CKD patients. We investigated 95 CKD patients, most of whom were older, aged 60 years or older (50.5%), and men (58.9%). This is in line with previous research in the field, demonstrating the potential vulnerability of these subgroups to both increased depression risk and decreased quality of life (26). Despite being conducted in a single but tertiary center, we believe that the sample is reasonably representative of a broader CKD population due to the inclusion of different age groups, genders, CKD stages, and comorbidities in Saudi Arabia.

The prevalence of comorbid diseases such as hypertension (82.1%), diabetes (74.7%), and dyslipidemia (42.1%) among CKD patients in this study was notable and aligns with prior findings. For instance, a US study showed that CKD patients had a similar prevalence of diabetes and hypertension to our study, which suggests the interrelationship between these diseases and the development of CKD (27). However, these comorbidities not only increase the progression of CKD but also affect its management and, therefore, affect the patient’s quality of life (11, 28).

Moreover, our study observed that most of our patients were in early stages of CKD, in which 73.7% were in stages 1–3, with a lower percentage of 26.3% in the late stages, stages 4 and 5. These observations align with those of the International Society of Nephrology, which indicates that CKD is usually diagnosed in its early stages (29). A possible explanation for this finding is the presence of screening efforts and increased awareness about CKD, which agrees with a Chinese study (30). Regardless of these efforts, the progression of CKD to late stages is still a major concern. This demonstrates the need for more effective interventions and more investigations into the factors that could affect the progression of the disease.

Additionally, this study showed that the median PHQ-9 score for depression among CKD patients was 12.0, which ranges from 0.0 to 27.0. We also found that the largest percentage of the patients suffered from moderate depression (28.4%), a less significant percentage suffered from moderately severe depression (23.2%), and 17.9% suffered from severe depression. These findings coincide with those of the Palmer et al. study, which indicates a significant occurrence of depression among CKD patients (31). Moreover, the disparity in the depression severity in this study illustrates the complex interplay of psychological factors that influence CKD patients, pointing out the importance of routine mental health assessment and a directed management plan. A possible explanation for the high severity scores of the depressive symptoms that are experienced by CKD patients is that these patients face significant emotional distress, which negatively impacts their quality of life and may affect their physical health.

Furthermore, when investigating the variables of higher PHQ-9 scores, we found that age 60 and older and female gender were significant. However, smoking status, BMI, comorbidities, illicit drug usage, and CKD stage were not significant predictors. Although smokers in our sample appeared to have lower PHQ-9 scores, the association was not statistically significant and should not be interpreted as protective. These findings are consistent with those of a Jordanian study, which indicated the possible susceptibility of these subgroups to develop more severe depressive symptoms (32). However, a possible explanation for the lack of significance for other factors is that the psychological burden and the effects on depression of CKD exceed the disease’s physical severity. As for this issue, addressing the mental and psychological needs of all CKD patients is required, regardless of their CKD stages or the presence of other comorbidities.

Moreover, several studies have found a strong association between depression and chronic conditions such as diabetes and hypertension; our findings did not suggest these associations. This may be related to sample size limitations and the presence of unmeasured confounding factors. Moreover, it is possible that the psychological effect of CKD may overshadow the effect of individual comorbidities on depression severity.

Also, our study found that there is a relationship between PHQ-9 score and poorer physical component summary (PCS12) and mental component summary (MCS12). This indicates that depression symptoms have a major impact on both the mental and physical health of CKD patients. This aligned with other research, which demonstrated that depression coexisting with CKD may have important additional adverse effects on functional status and physical health (31). Also, our study’s univariable analysis showed that age and diabetes are associated with lower PCS scores. However, in our multivariable analysis, only depressive symptoms remained a significant predictor of PCS scores. This indicates that depressive symptoms have a more significant effect on physical health. Other research revealed that depression was associated with subjective well-being, physical well-being, and environmental circumstances (33). Moreover, our study’s univariable analysis showed that the PHQ-9 score was a significant factor for mental component summary (MCS 12) scores.

Our study has several limitations. First, the sample size of only 95 patients restricts the generalizability of the results, which is one of the study’s many drawbacks, and this could also affect the subgroup analysis. Second, self-reported quality of life (MCS 12 and PCS 12) and depression (PHQ-9) assessments may have increased bias response. Due to another aspect that affects the accuracy of the findings, the patient may overreport or underreport depressive symptoms. Moreover, self-perception could be affected by temporary emotional conditions, which could affect the patient at the time of the interview. Third, patients’ sensitive variable details, such as illicit drug use, were based only on self-reported data collected from the patient. Data were not cross-validated with hospital records due to confidentiality issues. Lastly, uncontrollable factors that affect both depression and quality of life were not taken into consideration in this study, including socioeconomic status, cultural factors, medication adherence, and social support.

However, the study’s recruitment method, which relied on contact information from medical records and obtaining phone consent, may have introduced participation bias, as patients who were more ill, less motivated, or unreachable may be underrepresented. Additionally, response rates and refusal counts were not systematically recorded.

Finally, while our results support depression screening in CKD care, recommendations should be interpreted in the context of our single tertiary-center Saudi cohort. Broader application requires validation in multicenter and cross-cultural settings. In practice, screening could be integrated using brief tools like PHQ-9 during clinic visits. Positive screens should lead to structured referral pathways, staff training in symptom recognition, and inclusion of mental health professionals in nephrology teams. Further research is needed and should build on the limitations in our study to identify the complex relationship between CKD and the development of depression.

The purpose of the study was to ascertain the prevalence of depression in individuals with CKD, investigate and evaluate depression and QoL with various stages of the disease, and ascertain the relationship between these variables in CKD patients. We discovered that more than half of the patients had moderately to moderately severe depression, and nearly three-quarters of the patients were in the early stages of CKD. Furthermore, in comparison to the SF-12 questionnaire summary score cut-off, the CKD patients in our study exhibited lower quality of life levels. The significant risk factors for increased depression were female gender and age 60 and older. There was a negative link between the patient’s quality of life and the degree of depression, while other variables, including smoking status, BMI, comorbidities, illicit drug use, and CKD stage, were also not significant predictors. Patients with diabetes, those over 30, and the PHQ-9 score of depression were all found to be significantly linked with decreased PCS scores. The only significant factor for lower MCS scores was the PHQ-9 score for depression, as this was a cross-sectional study; these relationships represent associations and do not imply causality.

Lastly, we recommend using a validated questionnaire like the PHQ-9 to screen all CKD patients for depression, particularly those over 60 and women. In addition, treating depression in CKD patients implies a multidisciplinary team approach. Additionally, we advise educating CKD patients specifically about the dangers of depression and low quality of life, as well as providing ongoing care and monitoring. To clarify the risk of depression and low quality of life in patients with non-dialysis chronic kidney disease, larger sample sizes must be used in future studies.