Towards better illness perception in advanced chronic kidney disease: clinical, psychological and cognitive factors to address.

People with advanced chronic kidney disease (ACKD) frequently experience psychological distress due to the progressive nature of the illness and the burden of long-term treatment. Illness perception plays a critical role in emotional adjustment and health behaviors, yet the psychosocial and clinical variables shaping these perceptions are not fully understood. This study aimed to identify combinations of psychological, behavioral, and clinical factors that predict how individuals with ACKD perceive their illness, using a Qualitative Comparative Analysis (QCA) approach. The sample included 69 participants with ACKD. Illness perception was assessed via the Brief Illness Perception Questionnaire (B-IPQ). Predictive conditions included: anxiety (HADS-A), coping styles (Brief COPE), kidney disease knowledge (KiKS), emotional social support (MOS-SSS), neuroticism (NEO-FFI), and CKD stage. QCA results revealed multiple pathways to high illness threat perception. Configurations characterized by high anxiety, elevated neuroticism, and low active coping were consistently associated with negative illness representations. Conversely, combinations including greater disease knowledge and active coping predicted more adaptive perceptions. These findings underscore the relevance of addressing both emotional and cognitive variables when designing psychosocial interventions for people with ACKD, supporting a multidimensional approach to improving patient adjustment and health outcomes.