# Reno-Metabolic Multimorbidity and Psychiatric Comorbidity: Development of a Renal–Psychiatric/Psychosomatic Burden Score in a Real-World Cohort

## TL;DR

This study introduces a new score to assess the combined impact of kidney, metabolic, and mental health issues in patients, showing their interconnected effects on health outcomes.

## Contribution

The novel RePsy-Risk score integrates renal, metabolic, and psychiatric factors to quantify multimorbidity burden in a real-world cohort.

## Key findings

- The reno-metabolic group had higher serum creatinine and medication burden compared to the comparison group.
- RePsy-Risk strongly correlated with renal dysfunction, metabolic load, and psychiatric factors.
- Heatmap analysis revealed distinct clustering of renal-metabolic and psychosomatic dimensions.

## Abstract

Background and Objectives: Renal and metabolic disorders frequently coexist with psychiatric and psychosomatic conditions, forming complex multimorbidity clusters that challenge traditional models of care. Anxiety, depression, and stress-related disorders may amplify the clinical trajectory of chronic kidney disease (CKD) and metabolic dysfunction. This study aimed to characterize the renal–psychiatric/psychosomatic burden profile of a real-world clinical cohort and to introduce a novel integrative multimorbidity score (RePsy-Risk) quantifying the combined renal, metabolic, and psychiatric burden. Materials and Methods: We conducted a cross-sectional analysis of 148 adult patients stratified into a reno-metabolic group (group 1) and a comparison group with other comorbidities (group 2). Clinical, biochemical, and psychiatric data were extracted from routine medical records. RePsy-Risk was constructed from three domains: renal impairment (eGFR, UACR), metabolic load (TyG index, diabetes/metabolic diagnosis), and psychiatric/psychosomatic involvement (diagnostic text-mining, psychotropic treatment). Group differences were assessed using Mann–Whitney U and t-tests, and associations were explored via Spearman correlation and heatmap visualization. Results: The reno-metabolic group exhibited significantly higher serum creatinine (1.07 vs. 0.86 mg/dL, p = 0.0027), a greater medication burden (7.07 vs. 5.70 drugs, p = 0.0007), and a higher RePsy-Risk score (mean 4.11 vs. 3.20, p = 0.00028). Overall, 52.0% of patients were classified as low risk, 45.3% as moderate risk, and 2.7% as high risk. RePsy-Risk correlated strongly with renal dysfunction (eGFR: ρ = –0.62; UACR: ρ = 0.38) and with metabolic load (TyG: ρ = 0.53), while psychiatric factors contributed independently (RePsy_C: ρ = 0.48). Heatmap analysis confirmed clustering of renal and metabolic domains, with psychosomatic features forming a distinct but additive dimension. Conclusions: Reno-metabolic disease is associated with a significantly elevated renal–psychiatric/psychosomatic burden, shaped by the interplay between impaired renal function, metabolic stress, and psychiatric comorbidity. The RePsy-Risk score offers a practical tool for capturing this multidimensional vulnerability, highlighting the need for integrated clinical strategies that simultaneously address renal, metabolic, and mental health pathways. Further validation in larger cohorts is warranted.