Dialysis is life-sustaining management for patients who have lost renal function due to kidney failure[1,2]. Although it can be an effective treatment for many, it is a complex and demanding procedure that can have significant effects on patients’ physical, mental and emotional well-being[3,4]. Depression is a prevalent mental health issue that dialysis users regularly experience[5]. A sensation of despair, hopelessness and helplessness characterizes this syndrome[6]. The stress and ambiguity of treating a chronic illness such as renal failure, as well as the other lifestyle changes that occur alongside dialysis therapy, such as changes to one’s diet and daily routine, may all contribute to the onset of depression[7].

According to one study, depression can dramatically affect dialysis patients’ quality of life[8]. This can result in psychological and physical symptoms such as weariness, sleeplessness, lack of appetite and loss of interest in previously rewarding activities[9]. Furthermore, depression might make it more difficult for patients to stick to their treatment plan, exacerbating physical symptoms and resulting in poorer health outcomes[10-12]. Several studies have been conducted in recent years to investigate the link between dialysis and depression[13-17]. According to several studies[18-21], depression is more prevalent among dialysis patients than among the general population. Additionally, another study suggests that certain characteristics, such as dialysis duration or changes in dialysis, may increase the incidence of depression[22,23].

A research methodology that studies the organization of academic literature to indicate research trends, patterns and areas of competence is bibliometric and visualization mapping. We may acquire a clearer grasp of the field’s structure and geography, identify gaps in knowledge and highlight key contributions by using this methodology to study dialysis and depression[24-27]. This paper reviews the current state of dialysis and depression research, identifies the most influential research publications and institutions and outlines prospective future research directions. It also seeks to provide a complete overview of dialysis and depression research, highlight major research trends and knowledge gaps, and make recommendations for future research. In addition, this study can help researchers to identify voids in the current literature and guide future efforts to advance our understanding of the complex relationship between dialysis and depression.

Bibliometric analysis is a useful method for evaluating the global research landscape of a specific field. This work’s analysis provides insights into the research on depression and dialysis, demonstrating that it has been a topic of interest to scientists worldwide. The prominence of the USA, Turkey and China suggests that these nations may have made distinctive contributions to the discipline. This analysis also yields the identification of notable contributors, such as institutions, journals and funding agencies. These contributors may serve as valuable resources for future researchers seeking collaboration or funding. Identified trends and concentrations in the field of research can help to guide future investigations and inform policy decisions regarding depression and dialysis. Forecasting future developments is also beneficial for researchers, clinicians and policymakers who wish to anticipate future requirements and plan accordingly.

This study reveals that the amount of research evaluating the literature on dialysis and depression has increased consistently over the past two decades. In the foreseeable future, the amount of research into the connection between dialysis and depression is likely to increase. This is due to the increasing prevalence of chronic kidney disease (CKD) and the fact that depression is a common comorbidity among patients with CKD, especially those who require dialysis[69,70]. Furthermore, there is growing awareness among healthcare professionals of the impact that depression can have on the overall health and well-being of dialysis patients, as well as a greater emphasis on addressing mental health issues as part of comprehensive care[71,72]. As a result, it is reasonable to anticipate that research on this subject will continue to grow in the coming years.

Research studies to identify nations with a significant presence in a specific research discipline. In this case, the USA was determined to have the most influential research on depression and dialysis. This conclusion was likely reached by analyzing the number of publications and citations in these disciplines from various countries. It is not uncommon for countries to excel in particular areas of research while lagging behind in others[73-76]. Variables such as financial resources, government support, academic infrastructure, and cultural attitudes toward research contribute to scientific productivity. Countries such as Turkey, Iran and Brazil may have devoted more resources to depression and dialysis research, resulting in an increase in the number of publications. Additionally, these countries may have research questions or perspectives that have not been investigated as extensively in other regions. Notably, the connection between economic development and scientific productivity is intricate. Although it is true that countries with larger economies typically have more resources for research, there are numerous instances in which smaller or developing countries make significant scientific contributions. However, it is essential to note that research output does not necessarily equate to quality or influence. Other factors, such as funding, collaboration, and the caliber of research institutions, can also affect a country’s research influence[77]. It is also possible that other countries conduct high-quality research in these fields but are not recognized due to language barriers or lack of visibility[78].

The main themes of a research paper are usually reflected in the title and abstracts. When the terms depression and dialysis occur together frequently in a research field, it indicates current trends and progress in that area. Based on this cooccurrence, research on depression and dialysis can be categorized into three aspects: (1) “Prevalence of depression and anxiety among dialysis patients and gender differences”; (2) “Identification of depression as a potential risk factor for poor outcomes in dialysis patients”; and (3) “Effective interventions for alleviating depression in dialysis patients”.

The prevalence of depression and anxiety among dialysis patients, as well as gender differences, was one of the most important aspects of the study. There are gender differences in the prevalence and presentation of depression and anxiety in this population[79,80]. According to previous studies, women on dialysis are more likely to experience depression and anxiety than men[79-81]. Several factors, including fluctuations in hormones, social roles and cultural norms, might contribute to this[4,82].

The second hot topic was the “identification of depression as a potential risk factor for poor outcomes in dialysis patients”. According to previous findings, depression in hemodynamic patients is associated with a decline in the quality of life, an increase in mortality and an increase in healthcare costs[11,83-86]. Depression may also be linked to poor adherence to medicine and diet plans, a higher number of hospitalizations and a lack of social support[87]. Healthcare practitioners must be aware of the likelihood of depression in hemodynamic patients and perform routine screenings. Antidepressant drugs, psychotherapy and lifestyle changes can all be used to treat depression in patients[88,89]. Correctly diagnosing and treating depression in these patients can improve both their mental and physical health[88].

The third hot topic was “effective therapies to relieve depression in dialysis patients”. Enhancing the quality of life and health outcomes of dialysis patients involves the deployment of depression-fighting therapies[90,91]. Various therapies have been found to be useful for lowering depression in dialysis patients experiencing hemodynamic lysis[19,92,93]. One of the most widely utilized therapies is antidepressant medication. Antidepressant medication has been proven in various studies to be beneficial for reducing depressive symptoms in dialysis patients, as well as for improving other aspects of their health, such as sleep quality and pain management[94,95]. Cognitive behavioral therapy (CBT) is a successful treatment for depression in dialysis patients. CBT is a type of therapy that aims to change negative thought and behavior patterns[96-98]. Several studies have indicated that CBT can considerably reduce depressive symptoms and enhance dialysis patients’ quality of life[96,97]. In addition to CBT, exercise, music therapy and mindfulness-based therapies have been demonstrated to be helpful for treating depression in patients[92,99,100]. It has been shown that exercise enhances mood and reduces depressive symptoms in dialysis patients, whereas music therapy and mindfulness-based interventions may be helpful in the management of stress and anxiety.

Most research publications that involved dialysis patients before 2014 focused on the prevalence and gender differences of depression and anxiety and the identification of depression as a risk factor for negative outcomes in those patients. However, a marked change in research trends has been undertaken since 2014. The emphasis has shifted to focus on effective interventions that improve depression in dialysis patients. Thus, the research has acknowledged the value of addressing the practical elements in managing depression and improving the well-being of patients undergoing dialysis. The following future directions in this field are based on these findings. Although this issue to explore gender differences in the prevalence of depression and anxiety among patients undergoing dialysis was prevalent before 2014, further research may be needed for a deeper understanding of the factors that contribute to gender differences and their effects on treatment and outcome. Previous research has focused mainly on studying the correlation between depression and adverse outcomes, but it is necessary to continue to evaluate the relationship and understand the underlying mechanism of depression’s impact on the well-being of patients treated with dialysis. Recent articles focus primarily on methods to help people with depression. In the future, researchers should study various treatments such as medication therapies and social support to determine the most effective methods for alleviating depression in these patients. Research is needed to investigate the psychological and social factors causing depression and anxiety in patients who require dialysis. This involves assessing factors such as economic difficulties, stress management strategies, the presence of strong support systems and other relevant factors that can influence the development and deterioration of depression in this particular patient group. It is essential to acknowledge the lasting effects of therapeutic interventions on the mental and overall health of dialysis patients. By conducting long-term studies and follow-up evaluations, we can gain valuable information regarding the long-term efficacy and sustainability of various treatment approaches.

By utilizing bibliometrics, this study took a novel approach to understanding the academic literature on the relationship between dialysis and depression. Researchers could easily identify study participants, focal areas of interest and emerging patterns within this specific domain by utilizing visual analysis. Although these methods were useful in identifying research trends and knowledge gaps, they did have some limitations. Firstly, there was a potential risk of bias in the selection of publications and the inability to capture the full complexity of research topics. This was mainly due to our search being limited to Scopus, which, although comprehensive and reputable for numerous academic fields, might have omitted papers from alternative sources such as PubMed and Web of Science. Secondly, the list of keywords used in the study was derived from previous literature reviews and it is possible that some keywords were omitted, resulting in false-negative findings. Thirdly, as the citation searches were time dependent, older articles were more likely to be cited, which may have influenced the study findings. Fourthly, the scope of the investigation was limited to the search for the title and specific search phrases related to dialysis and depression, which may have led to the omission of relevant articles that used different terms. Lastly, the limitations of the Scopus database resulted in the dispersion of research output from active institutions with multiple Scopus profiles and the omission of funding agency names due to variations in publication naming conventions. Therefore, it is essential to refrain from manipulating or merging the Scopus output and to restrict data analysis to the specified method.

This study investigated the growth, trends and research topics associated with depression in dialysis patients. Analysis of 800 documents published between 1970 and 2022 revealed a significant increase in research activity over the past two decades, emphasizing the significance of addressing this common psychological condition in dialysis patients. In addition to the USA as the main contributor, Turkey, China and Iran have also made substantial contributions to the field. The study identifies key research areas and three major clusters of findings: gender differences in depression distribution; depression as a risk factor; and effective depression treatments. These findings contribute to the knowledge concerning gender-specific depression in dialysis patients and the development of effective strategies to improve their mental health. In addition, this report proposes future research directions, given the increasing emphasis on effective treatments for depression in dialysis patients. The study highlighted the growing awareness of the influence of depression on treatment adherence and health outcomes in this population. This study contributed to the advancement of knowledge in its field by indicating the way forward for future research on depression treatments for dialysis patients.

The author thanks An-Najah National University for all its administrative assistance during the implementation of the project. In addition, the author thanks Drs. Waleed Sweileh and Sa’ed H. Zyoud for helping and validating the research strategy.