Background: Psychological distress is common in hemodialysis patients and is linked to worse clinical outcomes and lower quality of life. Nutritional and inflammatory disturbances may impact emotional well-being. Gender likely acts as a biological and psychosocial modifier. This study examined the link between depression, anxiety, and stress in hemodialysis patients and a broad range of biochemical markers, focusing on gender as a main factor. Methods: A cross-sectional study included 54 adults on maintenance hemodialysis at a hospital in Madrid, Spain. Emotional distress was measured using the DASS-21. Predialysis biochemical markers assessed were β₂-microglobulin, albumin, hemoglobin, hematocrit, phosphorus, potassium, iron, calcium, and vitamin D. Statistical analyses included Spearman correlations, HC3-robust regressions with Gender × Biomarker interactions, false discovery rate correction (q = 0.10), penalized regressions (ridge/LASSO), partial least squares structural equation modeling (PLS-SEM), and mixed-cluster analysis. Results: Women reported higher depression, anxiety, and stress, and had lower albumin, calcium, and vitamin D (p < 0.05). Depression was independently linked to female gender, lower calcium, and the Gender × β₂-microglobulin interaction (adjusted R² = 0.30). In PLS-SEM analysis, a latent global psychological distress measure was directly related to β₂-microglobulin and inversely related to albumin and calcium (R² = 0.47). Nutritional markers partly mediated the gender–distress link. Cluster analysis found three biopsychosocial profiles: metabolically balanced, catabolic–emotional, and resilient–compensated. Conclusions: Gender shapes the relationships among inflammation, nutrition, and psychological distress in hemodialysis. Including gender-sensitive emotional and nutritional assessments in nephrology nursing could foster more personalized and practical care. Findings highlight the value of gender-aware psycho-nutritional screening in dialysis.

Background and Objectives: Psychological resilience is central to emotional adaptation in patients undergoing maintenance hemodialysis (HD). Although psychosocial determinants have been widely studied, the role of routinely monitored biochemical markers remains insufficiently defined. Materials and Methods: This study examined the associations between selected metabolic–inflammatory biomarkers and psychological resilience in adults receiving maintenance HD and explored potential gender-related differences. Resilience was assessed using the Resilience Scale–14 (RS-14). β₂-microglobulin, serum albumin, calcium, and 25-hydroxyvitamin D were analyzed as continuous predictors. Multiple linear regression models with heteroscedasticity-consistent robust standard errors (HC3) were adjusted for age, HD vintage, diabetes, and cardiovascular disease. Two interaction terms (Gender × β₂-microglobulin and Gender × albumin) were specified a priori. Model stability was evaluated using nonparametric bootstrap resampling (5000 iterations) and penalized regression with cross-validation. Results: In bivariate analyses, higher β₂-microglobulin levels were associated with lower resilience (ρ = −0.24; p = 0.041), whereas serum albumin showed a positive but non-significant association (p = 0.14). These relationships did not remain statistically significant in fully adjusted models (β₂-microglobulin: p = 0.107). No Gender × Biomarker interaction reached statistical significance (p = 0.162). Stratified analyses showed consistent directional patterns across gender groups. Conclusions: Metabolic–inflammatory biomarkers, particularly β₂-microglobulin and serum albumin, may be associated with psychological resilience in HD. However, gender-specific effects were not supported in adjusted analyses. These findings require validation in larger, longitudinal, multicenter studies.