Perceived stress is linked to depression but not to clinical outcomes in maintenance hemodialysis patients

Background/Objectives: Over the course of end-stage renal disease, patients undergoing hemodialysis (HD) often face significant psychological distress. Nonetheless, little is known about perceived stress levels and related factors in HD patients. This is a cross-sectional study that explores the prevalence of perceived stress levels and the associated variables in HD patients. Methods: Participants included 223 HD patients recruited in June 2024 in Italy. Perceived stress and depression levels were measured with the Perceived Stress Scale (PSS) and Beck Depression Inventory (BDI-II). We also collected clinical and laboratory variables to evaluate their association with PSS. Results: PSS score was moderate in 70.8% and high in 11.2% of the patients. The BDI score was significantly higher in patients with moderate or high perceived stress than in those with low perceived stress. The correlation between PSS and BDI scores was statistically highly significant, and in multivariate regression analysis, PSS score was independently associated with BDI, but not with age, sex, and serum creatinine. Patients with moderate or high perceived stress more frequently had a BDI ≥ 17. In women, with respect to men, the frequency of high and moderate perceived stress was higher. PSS does not correlate with some clinical characteristics such as functional disability (ADL and IADL scores), and the number of comorbidities (Charlson comorbidity Index). Also, we found that there was no correlation between PSS and post-dialysis fatigue prevalence/characteristics, nor between PSS and time of recovery after dialysis. Conclusions: These findings emphasize the critical need for targeted interventions addressing stress management in HD patients, especially with gender-specific approaches.