Alexithymia; an often missed condition prevelant in the practice of nephrology

Abstract

Aim: Alexithymia is a disorder associated with difficulty in recognizing and expressing feelings, which can lead to an increased susceptibility to disease development that makes alexithymia a possible risk factor for chronic kidney disease (CKD). This study was performed to evaluate for alexithymia in pre-dialysis CKD and end-stage renal disease patients undergoing hemodialysis.
Material and Method: The study was conducted in the Nephrology Outpatient Department and Hemodialysis unit of Ümraniye Research and Training Hospital. The patients had to have a diagnosis of CKD. Demographic data form, routine biochemical follow up data of patients, Toronto Alexithymia Scale (TAS), and Hospital Depression and Anxiety Scale (HADS) were used in this study. The statistical significance level was determined as p<0.05.
Results: A total of 111 patients (mean age 58.10±13.48 years, 61% female) were included in the study, 83.9% of whom were found to have alexithymia. The incidence of alexithymia in CDK patients was significantly higher than that in the control group (p=0.004); however, no statistically significant difference was detected in its incidence between the hemodialysis and pre-dialysis groups (p>0.05). The results showed that increased incidence of depression resulted in a 4.47-fold (p=0.035) increase in the incidence of alexithymia.
Conclusion: Alexithymia has been found to be high in patients with chronic kidney disease. Therefore, it is essential that we be aware of patients’ emotional stress and assess them for depression, anxiety, and alexithymia.

Keywords

• Alexithymia
• chronic kidney disease
• hemodialysis

References

1. Ammirati AL. Chronic kidney disease. Rev Assoc Med Bras 2020; 66: 53–9.
2. Agarwal AK, Ahmad S, Allon M. Handbook of dialysis; Wolters Kluwer Health: Philadelphia, PA, USA, 2015; ISBN 9781451144291.
3. Ibrahim S, El Salamony O. Depression quality life and malnutrition- inflammation scores in hemodialysis patients. Am J.Nephrol 2008; 28: 784–91.
4. Pop-Jordanova N, Polenakovic M. Alexithymia construct in dialysis patients. BANTAO Journal 2015; 12: 45–51.
5. Akyuz O, Parmaksiz E, Ardahanli I. Investigation of the relationship between Biochemical Parmeters, Alexithymia and Stress levels in hemodialysis patients. South Clin IstEuras 2021; 32: 13–8.
6. Christensen AJ, Ehlers SL. Pyschological factors in end stage renal disease: An emerging context for behavioral medicine research. J Consult Clin Psychol 2002; 70: 712–24.
7. Herrmann C. International experiences with the hospital anxiety and depression scale-a review of validation data and clinical results. J Psychosomatic Res 1997; 42: 17–41.
8. Salbas E. The Twenty-Item Toronto Alexithymia Scale (TAS-20), 2016. Available at: http://www.ftronline.com/toronto-aleksitimi-olcegi/. Accessed May 20, 2017.

9. Mattila AK, Salminen JK, Nummi T, Joukamaa M. Age is strongly associated with alexithymia in the general population. J Psychosomatic Research 2006; 61: 629-35.
10. Salminen JK, Saarijärvi S, Äärelä E, Toikka T, Kauhanen J. Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland. J Psychosomatic Research 1999; 41: 75-82.
11. Loas G, Fremaux D, Otmani O, Verrier A. Prevalence of alexithymia in a general population. Study in 183 “normal” subjects and in 263 students. Annales Medico-psychologiques 1995; 153: 355-7.
12. Batıgün AD, Büyükşahin A. Alexityhmia: Psychological Symptoms and Attachment Styles. Klinik Psikiyatri 2008; 11:105–14.
13. Pojatić Đ, Tolj I, Pezerović D, Degmečić D. Systematic review of alexithymia in the population of hemodialysis patients. J Clin Med 2021; 10: 28-62.
14. Lai C, Aceto P, Luciani M, et al. Emotional management and biological markers of dietetic regimen in chronic kidney disease patients. Ren Fail 2017; 39: 173-8.
15. Onor M, Trevisiol M, Spano M, Aguglia E, Paradiso S. Alexithymia and aging: a neuropsychological perspective. J Nerv Ment Dis 2013; 198: 891-5.
16. Fukunishi, I. Psychosomatic aspects of patients on hemodialysis. With special reference to aged patients. Psychother Psychosom 1989; 52: 51-7.
17. Pojatić Đ, Nikić D, Tolj I, Pezerović D, Šantić A, Degmečić D. Alexithymia, phosphorus levels, and sleep disorders in patients on hemodialysis. J Clin Med 2022; 11: 3218.
18. Besharat MA, Shahidi S. What is the relationship between alexithymia and ego defense styles? A correlational study with Iranian students. Asian J. Psychiatry 2011; 4: 145-9.
19. Cabras PL, Albanesi G, Calabresi M, Martinelli F. Chronic dialysis and forcing of the ability to fantasize. Evaluation of the alexithymic phenomenon in a group of dialyzed patients. Riv Patol Nerv Ment 1983; 104: 213–23.
20. Aggarwal HK, Jain D, Dabas G, Yadav RK. Prevelance of depression, anxiety and insomnia in chronic kidney disease patients ant theirco-relation with the demographic variables. Pril 2017; 38: 35–44.
21. Loosman WL, Rottier MA, Honig A, Siegert CEH. Association of depressive and anxiety symptoms with adverse events in Dutch chronic kidney disease patients:a prospective cohort study. BMC Nephrol 2015; 16: 155.
22. Duan D, Yang L, Zhang M, Song X, Ren W. Depression and associated factors in Chinese Patients with chronic kidney disease without dialysis: a cross-sectional study. Front Public Health 2021; 9: 605-51.
23. Wang X, Shen B, Zhaung X, Weng X. Investigating factor associated with depressive symptoms of chronic kidney disease in Chine with type 2 diabetes. J Diabetes Res 2017; 17: 698-97.
24. Kojima M, Hayano J, Suzuki S, et al. Depression, alexithymia and long-term mortality in chronic hemodialysis patients. Psyhother. Psychosom 2010; 79: 303–11