Intradialytic Symptoms and Recovery Time in Patients on Thrice-Weekly In-Center Hemodialysis: A Cross-sectional Online Survey

Luis Alvarez, Deborah Brown, Dean Hu, Glenn M Chertow, Joseph A Vassalotti, Sarah Prichard, Luis Alvarez, Deborah Brown, Dean Hu, Glenn M Chertow, Joseph A Vassalotti, Sarah Prichard

Abstract

Rationale & objective: Patients experience various symptoms during hemodialysis. We aimed to assess the frequency and severity of symptoms during hemodialysis and whether intradialytic symptoms are associated with recovery time postdialysis.

Study design: An online questionnaire was sent to 10,000 patients in a National Kidney Foundation database.

Setting & participants: Adult patients receiving in-center hemodialysis 3 times weekly for 3 or more months.

Exposure: Online questionnaire.

Analytic approach: Tabulation of frequency and severity of events and recovery time as percent of respondents, construction of a total symptom score, followed by rank correlation analysis of symptom characteristics with total recovery time.

Outcomes: Patient-reported intradialytic symptoms and recovery time postdialysis.

Results: 359 patients met screening criteria and completed the questionnaire. Mean age was 62.5 ± 13.8 years, 207 (58%) were men, 74 (21%) were black/African American, 132 (37%) had diabetes, 252 (70%) had hypertension, and 102 (28%) had a history of myocardial infarction, heart surgery, or stent placement. 311 (87%) patients had symptoms during dialysis in the previous week, with mean severity of 2.7 (range for each symptom, 1-5). The most common symptoms were fatigue/feeling washed out (62%), cramps (44%), and symptoms of low blood pressure (42%). Median time to recovery was 3 (range, 0-24) hours, and this correlated with the incidence and severity of intradialytic symptoms (P < 0.0001). 40% of patients had time to recovery times of 4 hours or longer. 1 in 3 patients reported having stopped dialysis early for intradialytic symptoms and 6% reported skipping dialysis at least once because of intradialytic symptoms.

Limitations: Recall-based self-reported data with a relatively low response rate.

Conclusions: A majority of patients receiving in-center hemodialysis experience symptoms such as feeling washed out, fatigue, and cramping; these may be severe and are correlated with longer recovery time following hemodialysis, as well as shortened and skipped hemodialysis sessions.

Keywords: hemodialysis; recovery time; symptoms.

© 2019 The Authors.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Prevalence and severity of reported symptoms. (Left panel) Percent of patients who report having each of the 12 symptoms in the questionnaire during their 3 dialysis sessions in the previous week. (Right panel) Mean severity reported for each of the 12 symptoms.
Figure 2
Figure 2
Percent of patients by number of symptoms per patient.
Figure 3
Figure 3
Recovery time postdialysis.
Figure 4
Figure 4
Relationship of recovery time versus number of symptoms. The correlation coefficient of recovery time as a function of number of symptoms per patient is 0.275 (P < 0.0001). Abbreviation: CI, confidence interval.
Figure 5
Figure 5
Relationship of recovery time versus total symptom score. Total symptom score for each patient was calculated by number of symptoms multiplied by the average severity of the symptoms. The correlation coefficient of recovery time as a function of the total symptom score is 0.279 (P < 0.0001). Abbreviation: CI, confidence interval.

References

    1. Saran R., Robinson B., Abbott K.C. US Renal Data System 2017 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2018;71(3 suppl 1)
    1. Danquah F.V.N., Zimmerman L., Diamond P.M. Frequency, severity, and distress of dialysis-related symptoms reported by patients on hemodialysis. Nephrol Nurs J. 2010;37:627–638.
    1. Caplin B., Kumar S., Davenport A. Patients’ perspective of haemodialysis-associated symptoms. Nephrol Dial Transplant. 2011;26:2656–2663.
    1. Nissenson A. Improving outcomes for ESRD patients: shifting the quality paradigm. Clin J Am Soc Nephrol. 2014;9(2):430–434.
    1. Flythe J.E., Assimon M.M., Wenger J.B., Wang L. Ultrafiltration rates and the quality incentive program: proposed measure definitions and their potential dialysis facility implications. Clin J Am Soc Nephrol. 2016;11(8):1422–1433.
    1. Weisbord S.D., Fried L.F., Mor M.K. Renal provider recognition of symptoms in patients on maintenance hemodialysis. Clin J Am Soc Nephrol. 2007;2:960–967.
    1. Assimon M.M., Flythe J.E. Intradialytic blood pressure abnormalities: the highs, the lows and all that lies between. Am J Nephrol. 2015;42:337–350.
    1. Dinesh K., Kunaparaju S., Cape K. A model of systolic blood pressure during the course of dialysis and clinical factors associated with various blood pressure behaviors. Am J Kidney Dis. 2011;58(5):794–803.
    1. Shoji T., Tsubakihara Y., Fujii M., Imai E. Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients. Kidney Int. 2004;66:1212–1220.
    1. Sands J.J., Usvyat L.A., Sullivan T. Intradialytic hypotension: frequency, sources of variation and correlation with clinical outcome. Hemodial Int. 2014;18:415–422.
    1. Kuipers J., Oosterhuis J.K., Krijnen W.P. Prevalence of intradialytic hypotension, clinical symptoms and nursing interventions - a three-months, prospective study of 3818 haemodialysis sessions. BMC Nephrol. 2016;17:21.
    1. Lindsay R.M., Heidenheim P.A., Nesrallah G. Minutes to recovery after a hemodialysis session: a simple health-related quality of life question that is reliable, valid, and sensitive to change. Clin J Am Soc Nephrol. 2006;1:952–959.
    1. Rayner H.C., Zepel L., Fuller D.S. Recovery time, quality of life, and mortality in hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS) Am J Kidney Dis. 2014;64(1):86–94.
    1. Garg A.X., Suri R.S., Eggers P. Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis. Kidney Int. 2017;91:746–754.
    1. Jaber B.L., Lee Y., Collins A.J. Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis. 2010;56(3):531–539.
    1. Morfin J.A., Fluck R.J., Weinhandl D.E. Intensive hemodialysis and treatment complications and tolerability. Am J Kidney Dis. 2016;68(5 suppl 1):S43–S50.
    1. Chan K.E., Thadhani R.I., Maddux F.W. Adherence barriers to chronic dialysis in the United States. J Am Soc Nephrol. 2014;25:2642–2648.
    1. Obialo C.I., Hunt W.C., Bashir K., Zager P.G. Relationship of missed and shortened hemodialysis treatments to hospitalization and mortality: observations from a US dialysis network. Clin Kidney J. 2012;5:315–319.
    1. Saran R., Bragg-Gresham J.L., Rayner H.C. Nonadherence in hemodialysis: associations with mortality, hospitalization, and practice patterns in the DOPPS Kidney. Int. 2003;64:254–262.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe