Diagnostic accuracy and practical utility of depression screening questionnaires across renal replacement therapy modalities

Depression is common yet underdiagnosed in patients receiving renal replacement therapies (RRT). Several questionnaires have shown utility for depression screening, mainly among in-centre haemodialysis patients; however, no instruments have been evaluated for diagnostic accuracy in home dialysis or kidney transplant populations. This study aimed to assess the diagnostic performance of the Beck Depression Inventory–Second Edition (BDI-II), the Beck Depression Inventory–Fast Screen (BDI-FS), and the Depression Subscale of the Hospital Anxiety and Depression Scale (HADS-D) across RRT modalities and to identify the most efficient tool for clinical use. Adult patients across RRT modalities completed the BDI-II, BDI-FS, and HADS-D, and were evaluated with the Structured Clinical Interview as the reference standard. Among the 203 included patients (mean age 67.3 years; 65% male), 18.2% met SCID-I criteria for depression. Optimal cut-offs were BDI-II ≥15 for in-centre haemodialysis and ≥ 16 for home dialysis and transplantation; BDI-FS ≥3 for in-centre and home dialysis and ≥ 4 for transplantation; and HADS-D ≥ 5 for in-centre haemodialysis and ≥ 6 for home dialysis and transplantation. Sensitivity and negative predictive values exceeded 90% for all instruments except the HADS-D, which showed lower sensitivity in transplanted (86.7%) and home dialysis patients (70%). The BDI-II, BDI-FS, and HADS-D are useful for depression screening in renal populations, though the HADS-D demonstrated reduced performance in home dialysis. Standard cut-offs were inadequate, and modality-specific thresholds improved diagnostic accuracy. The BDI-FS, combining strong accuracy with brevity and ease of use, emerged as the most efficient tool for routine screening across RRT modalities. • Depression screening tools require cut-offs tailored to each renal treatment modality. • The Beck Depression Inventory-Second Edition is accurate but too long for routine use. • The Beck Depression Inventory Fast Screen matches accuracy and is easier to administer. • The Hospital Anxiety and Depression Scale shows lower sensitivity, especially in home dialysis. • The Beck Depression Inventory Fast Screen may be the most suitable tool in all renal replacement treatments.