*Purpose: Anxiety and depression are frequent concerns in kidney transplant recipients and are associated with non-adherence and worse clinical outcomes. However, they are often underrecognized due to lack of inquiry. We have recently validated the Edmonton Symptom Assessment System-revised (ESASr) in kidney transplant recipients for symptoms assessment. Here we asses the measurement characteristics of ESASr to screen for anxiety and depression.

*Methods: A cross-sectional sample of stable kidney transplant recipients completed legacy instruments (patient health questionnaire (PHQ-9) and generalized anxiety disorder (GAD-7)) and the ESASr. In this analysis we focused on the ESASr-A (anxiety) and ESASr-D (depression) items. The correlation between the legacy and ESASr scores was compared using spearman’s rho. Discrimination was assessed using receiver operating characteristic (ROC) analysis. We determined the cut-off to identify potential “cases” that require further assessment using Youden’s J. We also constructed a Bayesian conditional probability plot integrating pre-test probability and likelihood ratios.

*Results: Mean(±SD) age of the 270 participants was 51 (±16), 61% were male and 55% Caucasian. Spearman’s correlation between ESASr and the legacy questionnaires was moderately strong (ESASr-A/GAD-7: 0.64; ESASr-D/PHQ-9: 0.61). Good discrimination was found on ROC analysis (area under the curve ESASr-A 0.86; ESASr-D 0.82) (Figure 1.). From the ROC, the optimal cut off was ≥4 for ESASr-A (Sensitivity = 0.75; Specificity = 0.86) and ≥2 for ESASr-D (Sensitivity = 0.75; Specificity = 0.77).

*Conclusions: ESAS-A and ESAS-D show good correlation with the respective legacy questionnaires. The identified cut-offs show good discrimination for moderate anxiety/depression (NPV and sensitivity). The findings may support the potential for ESASr use as an initial screening tool, with the ability to identify cases with only a few false negatives. Positive results can be paired with a second screening tool to identify true cases.

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