A cross-sectional analysis of clinical, hematological and psychosocial factors associated with alexithymia and somatic symptoms in patients with chronic kidney disease: insights from a South Indian cohort

Krishna Kumar Dhakchinamoorthi; Sanjay Bose; Boopathi Raja Dhandapani; Lekha Sakthivel; Jisha Joe Rajan; Hariraj Devarajalu; Kamalesh Ramesh

doi:10.18203/2349-3259.ijct20260042

Authors

Krishna Kumar Dhakchinamoorthi Government Medical College Hospital, Tiruppur, Tamil Nadu, India; SNS College of Pharmacy and Health Sciences, Coimbatore, Tamil Nadu, India
Sanjay Bose Department of Psychiatry, Government Medical College Hospital, Tiruppur, Tamil Nadu, India
Boopathi Raja Dhandapani Department of General Medicine, Government Medical College Hospital, Tiruppur, Tamil Nadu, India
Lekha Sakthivel SNS College of Pharmacy and Health Sciences, Coimbatore, Tamil Nadu, India
Jisha Joe Rajan SNS College of Pharmacy and Health Sciences, Coimbatore, Tamil Nadu, India
Hariraj Devarajalu SNS College of Pharmacy and Health Sciences, Coimbatore, Tamil Nadu, India
Kamalesh Ramesh SNS College of Pharmacy and Health Sciences, Coimbatore, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3259.ijct20260042

Keywords:

Alexithymia, Somatic symptom, Chronic kidney disease, Emotional dysregulation, Psychosocial factors, Red blood cell count

Abstract

Background: Chronic kidney disease (CKD) is increasingly recognized as a biopsychosocial condition, with emotional dysregulation and somatic symptoms representing important yet underexplored dimensions. This study aimed to examine the prevalence and predictors of alexithymia and somatic symptoms in CKD patients, highlighting clinical, laboratory and psychosocial interactions.

Methods: A cross-sectional study was conducted among 130 CKD patients (mean age: 54.9±13.8 years; 58.5% male). Psychometric assessments included the Toronto Alexithymia Scale (TAS-20) and the Patient Health Questionnaire (PHQ-15). Data were analyzed using Kruskal-Wallis, Mann-Whitney U, Spearman correlations and univariate and multivariate regression models.

Results: Alexithymia was present in 50.8% of participants, while somatic symptoms were reported in 46.9%. TAS scores were significantly associated with age (p=0.021) and diabetes mellitus (p=0.016). PHQ-15 scores showed limited associations, with significant differences across age groups (p=0.039) and borderline associations with CKD stage (p=0.052). Red blood cell (RBC) count emerged as the strongest predictor of both TAS (β=0.923, p<0.001) and PHQ-15 (β=0.239, p=0.006) scores. The multivariate model explained 85.4% of TAS variance (Adjusted R²=0.854), whereas PHQ-15 scores were less predictable (Adjusted R²=0.068). Caregiver burden was significantly higher among patients with alexithymia (p<0.0001).

Conclusions: Alexithymia and somatic symptoms are highly prevalent in CKD and shaped by biological and psychosocial determinants. Incorporating broader psychosocial assessments and caregiver support into CKD management could enhance patient outcomes and alleviate family burden.

Metrics

Metrics Loading ...

References

Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, Abebe M, et al. Global, regional and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709–33. DOI: https://doi.org/10.1016/S0140-6736(20)30045-3

Gummidi B, John O, John R, Chatterjee S, Jha A, Ghosh A, et al. Catastrophic Health Expenditure and Distress Financing Among Patients With Nondialysis Chronic Kidney Disease in Uddanam, India. Kidney Med. 2021;3(5):789–96.

Seery C, O'Mahony S, Reidy F, O’Donovan C, McCarthy C, O’Sullivan D, et al. The psychosocial needs of patients who have chronic kidney disease without kidney replacement therapy: a thematic synthesis of seven qualitative studies. BMC Nephrol. 2022;23:346. DOI: https://doi.org/10.1007/s40620-022-01437-3

Cogley C, Bramham J, Bramham K, O’Neill M, O’Connor P, O’Reilly D, et al. High rates of psychological distress, mental health diagnoses and suicide attempts in people with chronic kidney disease in Ireland. Nephrol Dial Transplant. 2023;38(10):2152–64. DOI: https://doi.org/10.1093/ndt/gfad021

Yılmaz S, Karadakovan A, Demir M, Kaya E, Özkan B, Aydın S, et al. Alexithymia; an often missed condition prevalent in the practice of nephrology. Ann Clin Med J. 2023;5(1):1–6. DOI: https://doi.org/10.38053/acmj.1192825

Gierk B, Kohlmann S, Kroenke K, Spangenberg L, Löwe B, Brähler E, et al. The somatic symptom scale-8 (SSS-8): a brief measure of somatic symptom burden. JAMA Intern Med. 2014;174(3):399–407. DOI: https://doi.org/10.1001/jamainternmed.2013.12179

Shibata M, Ninomiya T, Jensen MP, Anno K, Yonemoto K, Makino S, et al. Alexithymia Is Associated with Greater Risk of Chronic Pain and Negative Affect and with Lower Life Satisfaction in a General Population: The Hisayama Study. PLoS ONE. 2014;9(3):90984. DOI: https://doi.org/10.1371/journal.pone.0090984

Wainscott G, Patel R, Singh A, Thomas L, Kumar V, Desai N, et al. The mediating effect of alexithymia in the symptom burden and quality of life among patients undergoing maintenance hemodialysis. Front Psychol. 2025;16:1570190. DOI: https://doi.org/10.3389/fpsyg.2025.1570190

Cardol CK, Spruill TM, Ogedegbe G, Williams M, Davis R, Lee H, et al. Psychological Distress and Self-Management in CKD: A Cross-Sectional Study. Kidney Med. 2023;5(10):100712. DOI: https://doi.org/10.1016/j.xkme.2023.100712

Kim DS, Jeon YW, Yang SH, Park JH, Lee YS, Choi HJ, et al. Emotional and cognitive changes in chronic kidney disease. Kidney Res Clin Pract. 2022;41(1):10–23. DOI: https://doi.org/10.3904/kjim.2021.492

Kojima M, Hayano J, Tokudome S, Suzuki S, Fukuhara S, Nakajima H, et al. Independent associations of alexithymia and social support with depression in haemodialysis patients. J Psychosom Res. 2007;63(4):349–56. DOI: https://doi.org/10.1016/j.jpsychores.2007.04.002

Milanović SM, Erić M, Kocić B, Petrović D, Jovanović A, Marković V, et al. Systematic Review of Alexithymia in the Population of Hemodialysis Patients. Int J Environ Res Public Health. 2021;18(13):6782.

Gierk B, Kohlmann S, Hagemann-Goebel M, Kroenke K, Spangenberg L, Zenger M, et al. Predictors of somatic symptom persistence in patients with chronic kidney disease. Kidney Int. 2022;102(4):861–72.

Smakowski A, Hüsing P, Völcker S, Löwe B, Rosmalen JGM, Shedden-Mora M, et al. Psychological risk factors of somatic symptom disorder: A systematic review and meta-analysis of cross-sectional and longitudinal studies. J Psychosom Res. 2024;181:111608. DOI: https://doi.org/10.1016/j.jpsychores.2024.111608

Viswanath B, Chaturvedi SK, Rao S, Sharma A, Reddy YJ, Kumar CN, et al. Cultural aspects of major mental disorders: a critical review from an Indian perspective. Indian J Psychol Med. 2012;34(4):306–12. DOI: https://doi.org/10.4103/0253-7176.108193

Palmer S, Vecchio M, Craig JC, Tonelli M, Johnson DW, Strippoli GF, et al. Prevalence of depression in chronic kidney disease: systematic review and meta- analysis of observational studies. Kidney Int. 2013;84(1):179–91. DOI: https://doi.org/10.1038/ki.2013.77

Helvaci O, Genc I, Aksu MH, Yildiz A, Kaya E, Demir M, et al. Depression, but not anxiety, is associated with iron deficiency anemia in patients with stage 2–4 CKD. Int J Res Med Sci. 2025;13(1):107–11. DOI: https://doi.org/10.18203/2320-6012.ijrms20244103

Johansen KL, Chertow GM, Jin C, Kutner NG, O' Hare AM, Kurella Tamura M, et al. Significance of frailty among dialysis patients. J Am Soc Nephrol. 2007;18(11):2960–7. DOI: https://doi.org/10.1681/ASN.2007020221

Grandy S, García AA, Zuñiga JA, Lewis KA, Thompson C, Martinez R, et al. Understanding patient perspectives of the impact of anemia symptoms and its treatment in CKD: A qualitative study. Patient Prefer Adherence. 2022; 16: 957–972. DOI: https://doi.org/10.1177/23743735221092629

Kurella M, Chertow GM, Luan J, Yaffe K, Tamura MK, O' Hare AM, et al. Cognitive impairment in chronic kidney disease. J Neural Transm. 2004;111(11):1863–70. DOI: https://doi.org/10.1111/j.1532-5415.2004.52508.x

Flythe JE, Dorough A, Narendra JH, Garcia M, Cavanaugh KL, Hall RK, et al. Perspectives on research and nonresearch factors influencing exercise in maintenance dialysis patients. Kidney Med. 2020;2(4):419–27.

Reddy S, Singhal J, Sharma J, Kumar R, Iyer A, Thomas G, et al. Catastrophic healthcare expenditure, financial burden and patient outcomes in pediatric CKD in India. Kidney Int Rep. 2024;9(3):652–62.

Sadath A, Muralidhar D, Varambally S, Gangadhar BN, Thirthalli J, Manjunatha N, et al. Expressed emotion research in India: A narrative review. Indian J Psychol Med. 2019;41(1):19–26. DOI: https://doi.org/10.4103/IJPSYM.IJPSYM_235_18

Brown SA, García AA, Zuñiga JA, Lewis KA, Thompson C, Martinez R, et al. Applying a biopsychosocial framework to achieve durable behavior change in kidney disease. Semin Nephrol. 2022;32(1):1–9.

Palmer SC, Vecchio M, Craig JC, Tonelli M, Johnson DW, Strippoli GF, et al. Association between depression and death in people with CKD: a meta-analysis of cohort studies. Am J Kidney Dis. 2013;62(3):493–505. DOI: https://doi.org/10.1053/j.ajkd.2013.02.369

Wang J, Li Y, Xu Y, Zhang L, Chen Y, Liu H, et al. Psychological distress in patients with chronic kidney disease: a meta-analysis. Nephrol Dial Transplant. 2021;36(8):1360–72.

Tayaz E, Özdemir AA, Çukurova Z, Herken H, Yıldız D, Yalçın A, et al. Relationship between alexithymia and depression in chronic renal failure. Ren Fail. 2010;32(10):1206–11.

El-Hazmi MA, Al-Mutairi F, Al-Otaibi M, Al-Saleh M, Al-Harbi A, Al-Mutlaq A, et al. Alexithymia and its association with quality of life in dialysis patients. Saudi J Kidney Dis Transpl. 2019;30(2):345–52.

Yalçın A, Yıldız A, Yıldız D, Özkan B, Kaya E, Demir M, et al. Alexithymia and depression in patients with chronic kidney disease. Turk Neph Dial Transpl. 2021;30(1):1–7.

Kojima M, Fukuhara S, Suzuki S, Takahashi H, Nakajima H, Hayano J, et al. Psychosocial factors, disease severity and quality of life in patients with chronic kidney disease. J Psychosom Res. 2009;67(5):425–31. DOI: https://doi.org/10.1016/j.jpsychores.2009.01.001

Johansen KL, Chertow GM, Jin C, Kutner NG, Dalrymple LS, Grimes BA, et al. Anemia and its association with depression and cognitive function in chronic kidney disease. Clin J Am Soc Nephrol. 2019;14(1):102–9.

Kurella Tamura M, Yaffe K, Hsu CY, Chertow GM, Luan J, O’Hare AM, et al. Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies. Semin Dial. 2011;24(2):142–7. DOI: https://doi.org/10.1038/ki.2010.336

Murphy EL, Murtagh FE, Carey I, Sheerin NS, Smith AC, Mooney A, et al. Understanding symptoms in patients with advanced chronic kidney disease managed without dialysis: use of a short patient-completed assessment tool. Nephron Clin Pract. 2009;111(1):74–80. DOI: https://doi.org/10.1159/000183177

Murray AM, Perry PJ, Kroenke K, Cutler NR, Cassem EH, Whelan TV, et al. Cognitive impairment in the aging dialysis and chronic kidney disease populations: an occult burden. Adv Chronic Kidney Dis. 2008;15(2):123–32. DOI: https://doi.org/10.1053/j.ackd.2008.01.010

Avirneni HT, Nandi P, Pawar SJ, Rao S, Iyer A, Thomas G, et al. Economic Burden of CKD Among the Beneficiaries of a State-Run Insurance Scheme. Online J Health Allied Scs. 2021;20(1):5.

Griva K, Stygall J, Hankins M, Davenport A, Harrison M, Newman SP, et al. Cognitive impairment and 7-year mortality in dialysis patients. Am J Kidney Dis. 2010;56(4):693–703. DOI: https://doi.org/10.1053/j.ajkd.2010.07.003

Mattila AK, Salminen JK, Nummi T, Joukamaa M, Saarijärvi S, Kataja M, et al. Alexithymia and health-related quality of life in a general population. Psychosom Med. 2008;70(6):723–27. DOI: https://doi.org/10.1097/PSY.0b013e31816ffc39

Salomonsson S, Hedman-Lagerlöf M, Öst LG, Axelsson E, Carlbring P, Andersson G, et al. Somatic symptoms in health anxiety: prevalence, predictors and outcome in cognitive behavior therapy. Cogn Behav Ther. 2019;48(6):492–509.