Abstract

Background and Aims: Cognitive impairment (CI) and depression are frequent comorbidities in chronic hemodialysis (HD) patients with substantial impact on health-related quality of life (HRQoL). This study examined their prevalence, predictors, and independent associations with HRQoL. Methods: A cross-sectional study enrolled 70 adult maintenance HD patients. Cognitive functioning was assessed with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA); depressive symptoms with the Beck Depression Inventory (BDI); and HRQoL with the Kidney Disease Quality of Life instrument (KDQOL-SF). Logistic regression, multiple linear regression, and mediation analysis were applied. Results: CI (MoCA ≤ 24) was present in 54.3% of patients; clinically significant depressive symptoms (BDI ≥ 14) were present in 44.4%. BDI was not correlated with MoCA (p = 0.656) or MMSE (p = 0.880), confirming independence of the two dimensions in cross-section. Older age (OR = 1.106, p = 0.001) and male sex (OR = 4.523, p = 0.022) were independent predictors of CI. BDI significantly correlated with 15 of 19 KDQOL domains and was the dominant predictor across 10 domains in multiple linear regression (Adj. R2 up to 0.358). MoCA correlated with only two KDQOL domains. Mediation analysis confirmed that MoCA does not mediate the BDI–HRQoL relationship (indirect effect: −0.004, 95% bootstrap CI: −0.106 to +0.097). Conclusions: CI and depression are highly prevalent and clinically distinct dimensions in HD patients, though subtle longitudinal interactions cannot be excluded. Depression is the dominant determinant of impaired HRQoL, acting through a direct, cognitively independent pathway, and represents the primary modifiable target for improving quality of life in this population.

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