Background Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD) are associated with substantial symptom burden and psychosocial distress. However, the relationship between physical symptoms and emotional distress is not always proportional. We introduce the symptom-psychosocial mismatch (SPM) construct and operationalize it using a novel mismatch index (MI). Methods In this cross-sectional study, 127 adults with CKD stages 3–5 or ESKD were recruited from a tertiary-care center. Symptom burden was assessed using the Edmonton Symptom Assessment Scale–Revised, and psychosocial distress using the Hospital Anxiety and Depression Scale and Distress Thermometer. The MI was calculated as Psychosocial Distress minus Symptom Burden (scaled 0–100). Values >+10 indicated psychosocial-dominant mismatch, <–10 symptom-dominant mismatch. Associations with Kidney Disease Quality of Life (KDQOL-36) were analyzed using correlation and multivariable regression. Results Mismatch was present in 63% of participants. Psychosocial-dominant mismatch predominated in earlier CKD, while symptom-dominant mismatch was more common in ESKD. The MI showed the strongest correlation with KDQOL ( r = –0.47, p <0.001) and remained an independent predictor of reduced quality of life (QoL) (β = –0.42, p <0.001). Conclusion Symptom–Psychosocial Mismatch is prevalent in CKD and ESKD and independently predicts QoL.
Randhawa et al. (Mon,) studied this question.