Introduction:
Non-adherence to pharmacological treatment and psychological distress are common among patients undergoing hemodialysis (HD), with significant consequences for morbidity, hospitalization, and quality of life. Although self-efficacy—defined as the belief in one's ability to manage illness-related challenges—has shown strong associations with both health behaviors and emotional outcomes, it remains underused in clinical screening. No brief tools are currently available that integrate self-efficacy as a dual predictor of behavioral and affective risk in nephrology.


Purpose:
To develop and preliminarily evaluate the B-CKD-HAS (Brief-Chronic Kidney Disease-Hemodialysis Adherence Scale), a concise, self-efficacy-based instrument aimed at identifying HD patients at risk of both medication non-adherence and depressive symptomatology.


Method:
A cross-sectional, multicenter study was conducted with 97 adult HD patients (mean age = 64.2 years, SD = 13.5; 58.7% male). Medication adherence was measured using the MMAS-8, and depressive symptoms with the Geriatric Depression Scale-Short Version (GDS-SV). Self-efficacy was assessed using the Chronic Kidney Disease Self-Efficacy Scale (CKD-SE) and the Self-Efficacy for Managing Chronic Disease Scale (SEMCD). Stepwise multiple regression identified six predictive items (VIF < 2.1; p < .01) which were combined into the B-CKD-HAS (score range: 6-30).


Results:
The final model predicted 56.8% of the variance in MMAS-8 scores (adjusted R² = .568; F(6,90) = 19.83, p < .001) and 32.0% of the variance in GDS-SV scores (adjusted R² = .320; F(6,90) = 7.44, p < .001). The most predictive item was related to food choices in social settings (β = 0.41, p < .001). Internal consistency of the B-CKD-HAS was acceptable (Cronbach's α = 0.8).


Conclusions:
The B-CKD-HAS offers a brief, statistically robust tool for identifying HD patients at dual behavioral and emotional risk. It may support early intervention, individualized care, and the integration of psychological constructs into routine nephrology. Ongoing psychometric validation will further establish its reliability and clinical value.