Symptom-Psychosocial Mismatch Common in Advanced CKD and ESRD: Study
A cross-sectional clinical observational study assessing physical and psychological symptom dynamics in advanced stages of chronic kidney disease (CKD) has led to the creation of a new diagnostic tool in nephrology. According to the results of this study, symptom-psychosocial mismatch (SPM) is very common in patients with CKD and end-stage kidney disease (ESKD) and can predict QoL. The study was published in the Indian Journal of Nephrology by Richa R. and fellow researchers.
To estimate the extent of the difference between physical pain and psychological distress, a cross-sectional observational study was conducted involving 127 patients with CKD stages 3–5 or ESKD recruited from a tertiary-care academic center. Physical symptom burden was assessed by means of the validated Edmonton Symptom Assessment Scale-Revised (ESAS-R) tool, while psychosocial distress was evaluated by the Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer (DT) scales.
To measure this discrepancy, the Mismatch Index (MI) was used and defined as the difference between the scaled Psychosocial Distress score and the scaled Symptom Burden score on a scale of 0–100. Participants were classified into different phenotyping subgroups based on the Mismatch Index results, where values above +10 meant a psychosocial dominant mismatch, and below -10 – a symptom dominant mismatch. The associations between the Mismatch Index and overall health-related quality of life were assessed by the Kidney Disease Quality of Life 36-item instrument (KDQOL-36).
Key findings:
- The statistical assessment on 127 patients with advanced CKD and ESKD showed a high prevalence of mismatch and strong independent predictive validity for overall health-related quality of life.
- There was significant symptom-psychosocial mismatch (MI > +10 or < −10) in 63% of the total study sample.
- Psychosocial-dominant mismatch (MI > +10) occurred frequently in the patients at the early stage of non-dialysis CKD, while symptom-dominant mismatch (MI < −10) was significantly higher in patients with end-stage kidney disease (ESKD).
- The Mismatch Index had the highest inverse correlation with KDQOL-36 scores in all studied parameters (r = −0.47, p < 0.001).
- The Mismatch Index is an independent negative predictor of quality of life in multivariable regression models after adjustment for demographic and clinical variables (β = -0.42, p < 0.001).
In conclusion, clinical cross-sectional data show that the mismatch between symptoms and psychosocial issues occurs frequently among CKD and ESKD patients. The conclusions drawn by the researchers highlight the importance of calculating the Mismatch Index, which acts as an independent predictor of quality of life.
Reference:
Randhawa, R., Randhawa, A., & R, J. (2026). Symptom–psychosocial mismatch in chronic kidney disease: Development and clinical implications of a novel mismatch index. Indian Journal of Nephrology, 0, 1. https://doi.org/10.25259/ijn_158_2026
