Key takeaways:

• About one in seven kidney transplant recipients had depressive symptoms at admission.
• Age, smoking status and frailty were linked to higher odds for high depressive symptoms.

Depressive symptoms may be prevalent for kidney transplant recipients before and after transplantation, according to study data published in Kidney360.

About 40% of patients with end-stage kidney disease experience depressive symptoms, which may be associated with adverse outcomes like CV events and mortality, according to Mara McAdams-DeMarco, PhD, professor in the departments of surgery and population health at New York University Grossman School of Medicine, and colleagues. However, studies evaluating the prevalence of depressive symptoms throughout the kidney transplant process are limited, they wrote.

Data derived from Huang NS, et al. Kidney360. 2026;doi:10.34067/KID.0000001260.

In a multicenter prospective cohort study, the researchers aimed to evaluate how depressive symptoms changed before and after kidney transplantation. They used the Center for Epidemiologic Studies Depression (CES-D) scale, which measures how frequently 20 symptoms of depression occurred during the past 7 days.

The data included 4,661 kidney transplant candidates (mean age, 55.2 years; 40% women; 46% non-Hispanic Black) and 1,215 kidney transplant recipients (mean age, 52.5 years; 40% women; 38% non-Hispanic Black) between 2008 and 2025.

Results showed that high depressive symptoms were present among 19% of kidney transplant candidates and 15% of kidney transplant recipients at admission.

Before kidney transplantation, candidates aged 60 years or younger (adjusted OR = 1.75; 95% CI, 1.48-2.07), women (aOR = 1.4; 95% CI, 1.2-1.64), current or previous smokers (aOR = 1.73; 95% CI, 1.48-2.02) and patients with frailty (aOR = 1.55; 95% CI, 1.22-1.97) were more likely to have high depressive symptoms, among other groups.

At time of admission for kidney transplantation, recipients aged 60 years or younger (aOR = 2.66; 95% CI, 1.68-4.21), current or previous smokers (aOR = 1.62; 95% CI, 1.12-2.34) and frail patients (aOR = 2.75; 95% CI, 1.67-4.54) were more likely to have high depressive symptoms.

Among kidney transplant recipients, depressive symptoms worsened over 4 years (CES-D slope = 0.42 points/year; 95% CI, 0.25-0.6).

Kidney transplant recipients who had high depressive symptoms before transplantation had fewer depressive symptoms after transplantation (difference = –1.18 points/year; 95% CI, –1.79 to –0.58), whereas recipients without high depressive symptoms before transplantation had more depressive symptoms after transplantation (difference = 0.53 points/year; 95% CI, 0.34-0.71). The increase in depressive symptoms did not reach the point of diagnosable clinical depression, according to the researchers.

“Restoration of kidney function via [kidney transplantation] lessens uremia, inflammation, sleep disturbance, and fatigue, all of which are drivers strongly implicated in depression,” McAdams-DeMarco and colleagues wrote. “However, patients without existing high depressive symptoms ... may have less room to improve, while also experiencing new stressors, including medical and/or surgical complications of [kidney transplantation], fear of graft loss, or financial strain.”

Furthermore, recipients with a preemptive kidney transplant had higher scores on the CES-D scale compared with recipients without a preemptive kidney transplant (difference = –0.57 points/year; 95% CI, –1.04 to –0.09).

Overall, the findings show that depressive symptoms may persist after kidney transplantation, according to the researchers.

More research is needed to explore how to identify patients who could benefit from a mental health intervention and optimal times to initiate treatment, the researchers wrote.

“Clinicians should discuss the long-term mental health impact of [kidney transplantation] and provide individualized support to preserve psychological well-being throughout the transplant process,” McAdams-DeMarco and colleagues wrote.