Introduction:
Patients on hemodialysis (HD) experience a convergence of chronic somatic, emotional, cognitive, and social stressors. These stressors increase their vulnerability to psychological and medical deterioration, yet conventional clinical assessments often overlook non-biomedical domains. Addressing this gap, we propose a preliminary integrative model of biopsychosocial frailty that includes depressive symptoms, illness perception, self-efficacy, social and nutritional wellbeing within the framework of a newly developed multidimensional tool: RESANNA-CKD-HD (Relational, Emotional, Social, Autonomy, Nutritional and Nephrological Assessment - Chronic Kidney Disease - Hemodialysis).


Purpose:
To investigate the predictive value of illness perception and self-efficacy on depressive symptoms in HD patients and evaluate how these factors interact with the multidomain structure of the proposed RESANNA-CKD-HD.


Method:
A cross-sectional multicenter study was conducted with 97 adult HD patients. The RESANNA-CKD-HD tool was constructed by selecting 20 non-redundant items from a pool of 172 based on significant correlations with frailty (Edmonton Frail Scale, p < .05; r or ρ > |0.30|). The items span seven domains: functional capacity, cognition, emotional state, illness perception, self-efficacy, nutritional indicators, and social support. Depressive symptoms were measured using the Geriatric Depression Scale-Short Version (GDS-SV). Illness representation and perceived competence were evaluated using the Brief Illness Perception Questionnaire (B-IPQ) and Chronic Kidney Disease Self-Efficacy (CKD-SE). Hierarchical multiple regression models were applied.


Results:
The RESANNA-CKD-HD model explained 92.4% of the variance in frailty scores and 54.6% of the variance in depressive symptoms. Illness perception (β = 0.36), emotional state (β = 0.33), and CKD-specific self-efficacy (β = -0.29) were identified as significant independent predictors of depression.


Conclusions:
This proposed model underscores the need to incorporate psychosocial constructs into frailty screening in HD. RESANNA-CKD-HD shows promise for guiding early identification and personalized care. Further validation studies are ongoing.