Depression is common in end-stage renal disease (ESRD) patients and has a negative effect on the quality of life, functional ability, and mortality, with a prevalence rate as high as 20-25%. However, it is hard to use anti-depressant due to the safety issue, and there has been little data so far particularly in terms of randomized clinical trials. Here, we investigate the effect of cognitive-behavioral group therapy for enhancing mental health and quality of life in patients with ESRD.

Inclusion Criteria:

• Patients with end-stage renal disease : on hemodialysis more than 3 months
• Patients with BDI-II score >= 15 points
• Adult with age >= 20 years old
• Patients who were able to understand and willing to sign the written informed consent

Exclusion Criteria:

• Patients on hemodialysis due to acute kidney injury
• Patients who are on admission
• Patients who are undergoing chemotherapy or radiation therapy due to progressive malignant disease
• Patients who are planning kidney transplantation within few months
• Patients with cognitive dysfunction, mental retardation, and drug addict
• Patients who are unavailable for adequate communication with researchers
• Patients who changed anti-depressive agent or dose within 2 months before/after the trial