Davorin Pezerović

Background/Objectives: Ego defense mechanisms are subconscious processes that help individuals cope with stressors from both external and internal realities. They are divided into three levels based on their adaptive function. Patients undergoing chronic hemodialysis are those who have been treated with this method for longer than three months. Only a few studies have examined the defense mechanisms in hemodialysis patients. Our study aimed to examine the association between ego defense mechanisms and alexithymia, depression, and sleep disorders, as well as clinical and biochemical variables, in a group of 170 hemodialysis patients. Methods: We used the Defense Style Questionnaire-40, the Toronto Alexithymia Scale-26, the Pittsburgh Sleep Quality Index, and the Hamilton Depression Inventory as our analyses methods. Clinical and biochemical variables, along with interdialytic weight gain, were measured before the hemodialysis session. Results: There was a positive correlation between the affect displacement and dissociation with leukocyte levels (Spearman’s rho = 0.192, p = 0.02; rho = 0.165, p = 0.04), and between autistic fantasy and phosphorus levels (rho = −0.163, p = 0.04). Depressive HD patients had higher levels of somatization, affect displacement, and splitting compared to the HD patients without depression (Man–Whitney U test, p = 0.005, p = 0.022, p = 0.045). There were higher levels of immature defense mechanisms in the group of patients with alexithymia than in the group without alexithymia (Mann–Whitney U test, p < 0.001). Conclusions: The immature defense mechanisms were our research model’s strongest predictive factor of alexithymia (OR = 1.87, 95% CI 1.27 to 2.75).

Alexithymia, or the inability to distinguish between bodily feelings and emotions, has been linked to poor sleep quality in some studies. Rare studies examined the associations between electrolyte phosphorus in patients on hemodialysis and their sleep quality, daytime sleepiness, and alexithymia with inflammatory factors. Hemodialysis is a treatment method for terminal renal patients that involves the diffusion of unwanted metabolic products through the dialyzer membrane. Our study aimed to examine whether there was a difference in phosphorus levels, inflammatory factors, and daytime sleepiness according to the hemodialysis patients’ levels of alexithymia. The study involved 170 HD patients that had been treated with chronic dialysis for more than three months. Prior to the hemodialysis procedure, laboratory findings were sampled. Respondents completed the Pittsburgh Sleep Quality Index, the Toronto Alexithymia Scale 26, and the Epworth Sleepiness Scale, and were questioned about depression. The results showed that alexithymic HD patients exhibited significantly higher leukocyte counts, lower predialysis phosphorus values, and more pronounced daily sleepiness than the alexithymia-free group (Mann–Whitney U test, p = 0.02, p = 0.005, and p < 0.001, respectively). We concluded that alexithymia was an independent predictor of high daytime sleepiness in HD patients (OR = 1.05, 95% CI 1.02 to 1.09).