Prevalence and associated factors of anxiety and depression among hemodialysis patients in Sudan during armed conflict: a multicenter cross-sectional study

BACKGROUND: Patients with chronic kidney disease (CKD) receiving hemodialysis are at high risk of depression and anxiety, especially in conflict settings where healthcare access is disrupted. No large-scale study in Sudan has simultaneously assessed depression and anxiety during armed conflict. This study aims to estimate the prevalence of anxiety and depressive symptoms and assess their associations with sociodemographic characteristics, dialysis duration, and comorbidities among hemodialysis patients in Sudan during the ongoing armed conflict. METHODS: A multicenter, cross-sectional study was conducted across 13 dialysis units in nine Sudanese states between April and December 2025. A total of 811 adult patients (≥ 18 years) on maintenance hemodialysis were recruited via convenience sampling. Depression and anxiety were assessed using the validated Arabic versions of the PHQ-9 and GAD-7, respectively. Binary logistic regression identified factors associated with depression and anxiety. RESULTS: The prevalence of depressive symptoms was 40.3% (n = 327) and anxiety symptoms 28.6% (n = 232). Comorbid diabetes mellitus (Depression: OR = 2.66, 95% CI: 1.71-4.13; Anxiety: OR = 2.01, 95% CI: 1.28-3.14) and use of neurotoxic medications were associated with higher odds of both conditions. Longer dialysis duration (> 12 months) was associated with lower odds. Female sex and lower dialysis frequency (one session/week) were uniquely linked to higher odds of depression, while older age (≥ 74 years) was protective against anxiety. Geographic variation was observed, with higher odds in Gadarif state. CONCLUSION: Depression and anxiety are highly prevalent among hemodialysis patients in Sudan, exacerbated by ongoing conflict. Diabetes, neurotoxic medications, and regional disparities are key associated factors. Targeted mental health screening and support should be integrated into nephrology care, focusing on high-risk subgroups and conflict-affected regions.