The confirmed finding that 1 in every 4-5 people with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) suffers from depressive symptoms or a major depressive disorder, a rate 4 times higher than in the general population, should give us pause, as CKD affects 10% of people worldwide.1-3 The less commonly reported observation that, in addition to depression, other severe mental disorders, such as bipolar disorder and schizophrenia, are also prevalent in our patients with kidney disease is even more daunting, although the prevalence has been less commonly characterized.