Dialysis symptom index burden and symptom clusters in a prospective cohort of dialysis patients

Amy S You, Sara S Kalantar, Keith C Norris, Rene Amel Peralta, Yoko Narasaki, Ronald Fischman, Michael Fischman, Avedik Semerjian, Tracy Nakata, Zahra Azadbadi, Danh V Nguyen, Kamyar Kalantar-Zadeh, Connie M Rhee, Amy S You, Sara S Kalantar, Keith C Norris, Rene Amel Peralta, Yoko Narasaki, Ronald Fischman, Michael Fischman, Avedik Semerjian, Tracy Nakata, Zahra Azadbadi, Danh V Nguyen, Kamyar Kalantar-Zadeh, Connie M Rhee

Abstract

Background: Dialysis patients experience a high symptom burden, which may adversely impact their quality of life. Whereas other specialties emphasize routine symptom assessment, symptom burden is not well-characterized in dialysis patients. We sought to examine the prevalence and severity of unpleasant symptoms in a prospective hemodialysis cohort.

Methods: Among 122 hemodialysis patients from the prospective Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease (CKD) study, CKD-associated symptoms were ascertained by the Dialysis Symptom Index, a validated survey assessing symptom burden/severity (with higher scores indicating greater symptom severity), over 6/2020-10/2020. We examined the presence of (1) individual symptoms and symptom severity scores, and (2) symptom clusters (defined as ≥ 2 related concurrent symptoms), as well as correlations with clinical characteristics.

Results: Symptom severity scores were higher among non-Hispanic White and Hispanic patients, whereas scores were lower in Black and Asian/Pacific Islander patients. In the overall cohort, the most common individual symptoms included feeling tired/lack of energy (71.3%), dry skin (61.5%), trouble falling asleep (44.3%), muscle cramps (42.6%), and itching (42.6%), with similar patterns observed across racial/ethnic groups. The most prevalent symptom clusters included feeling tired/lack of energy + trouble falling asleep (37.7%); trouble falling asleep + trouble staying asleep (34.4%); and feeling tired/lack of energy + trouble staying asleep (32.0%). Lower hemoglobin, iron stores, and dialysis adequacy correlated with higher individual and overall symptom severity scores.

Conclusion: We observed a high prevalence of unpleasant symptoms and symptom clusters in a diverse hemodialysis cohort. Further studies are needed to identify targeted therapies that ameliorate symptom burden in CKD.

Keywords: Dialysis; Symptom clusters; Unpleasant symptoms; Uremia.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Prevalence of individual symptoms in the overall cohort
Fig. 2
Fig. 2
Prevalence of individual symptoms across racial/ethnic groups: Non-Hispanic White (A), Black (B), Hispanic White (C), and Asian/Pacific Islander (D)
Fig. 3
Fig. 3
Prevalence of individual symptom pairings within symptom clusters in the overall cohort

References

    1. Kalantar-Zadeh K, Lockwood MB, Rhee CM, Tantisattamo E, Andreoli S, Balducci A, et al. Patient-centered approaches for the management of unpleasant symptoms in kidney disease. Nature Rev Nephrol. 2022;2022:1–4.
    1. Cabrera VJ, Hansson J, Kliger AS, Finkelstein FO. Symptom management of the patient with CKD: the role of dialysis. Clin J Am Soc Nephrol. 2017;12(4):687–693. doi: 10.2215/CJN.01650216.
    1. Kalantar-Zadeh K, Wightman A, Liao S. Ensuring choice for people with kidney failure—dialysis, supportive care, and hope. N Engl J Med. 2020;383(2):99. doi: 10.1056/NEJMp2001794.
    1. Rhee CM, Nguyen DV, Nyamathi A, Kalantar-Zadeh K. Conservative vs preservative management of chronic kidney disease: similarities and distinctions. Curr Opin Nephrol Hypertens. 2020;29(1):92–102. doi: 10.1097/MNH.0000000000000573.
    1. Zarantonello D, Rhee CM, Kalantar-Zadeh K, Brunori G. Novel conservative management of chronic kidney disease via dialysis-free interventions. Curr Opin Nephrol Hypertens. 2021;30(1):97–107. doi: 10.1097/MNH.0000000000000670.
    1. Ng MSN, Miaskowski C, Cooper B, Hui YH, Ho EHS, Mo SKL, et al. Distinct symptom experience among subgroups of patients with ESRD receiving maintenance dialysis. J Pain Symptom Manage. 2020;60(1):70–79. doi: 10.1016/j.jpainsymman.2020.01.004.
    1. Davison SN, Jhangri GS. Impact of pain and symptom burden on the health-related quality of life of hemodialysis patients. J Pain Symptom Manage. 2010;39(3):477–485. doi: 10.1016/j.jpainsymman.2009.08.008.
    1. Flythe JE, Tugman MJ, Narendra JH, Dorough A, Hilbert J, Assimon MM, et al. Feasibility of Tablet-Based Patient-Reported Symptom Data Collection Among Hemodialysis Patients. Kidney Int Rep. 2020;5(7):1026–1039. doi: 10.1016/j.ekir.2020.04.021.
    1. Weisbord SD, Fried LF, Mor MK, Resnick AL, Unruh ML, Palevsky PM, et al. Renal provider recognition of symptoms in patients on maintenance hemodialysis. Clin J Am Soc Nephrol. 2007;2(5):960–967. doi: 10.2215/CJN.00990207.
    1. Harley KT, Streja E, Rhee CM, Molnar MZ, Kovesdy CP, Amin AN, et al. Nephrologist caseload and hemodialysis patient survival in an urban cohort. J Am Soc Nephrol. 2013;24(10):1678–1687. doi: 10.1681/ASN.2013020123.
    1. Abdel-Kader K, Unruh ML, Weisbord SD. Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol. 2009;4(6):1057–1064. doi: 10.2215/CJN.00430109.
    1. Weisbord SD, Fried LF, Arnold RM, Fine MJ, Levenson DJ, Peterson RA, et al. Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients. J Am Soc Nephrol. 2005;16(8):2487–2494. doi: 10.1681/ASN.2005020157.
    1. Zamanian H, Taheri KZ. Translation and psychometric properties of the persian version of the dialysis symptom index in hemodialysis patients. Nephro-Urol Mon. 2015;7(1):e23152.
    1. Almutary H, Bonner A, Douglas C. Arabic translation, adaptation and modification of the dialysis symptom index for chronic kidney disease stages four and five. BMC Nephrol. 2015;16:36. doi: 10.1186/s12882-015-0036-2.
    1. Chaiviboontham S, Phinitkhajorndech N, Tiansaard J. Symptom clusters in patients with end-stage renal disease undergoing hemodialysis. Int J Nephrol Renovasc Dis. 2020;13:297–305. doi: 10.2147/IJNRD.S271619.
    1. Cho MK, Kim SY, Shim HY. Validity and reliability of the korean version of the dialysis symptom index for hemodialysis patients. J Nurs Res. 2018;26(6):399–410. doi: 10.1097/jnr.0000000000000267.
    1. van der Willik EM, Hemmelder MH, Bart HAJ, van Ittersum FJ, Hoogendijk-van den Akker JM, Bos WJW et al (2021) Routinely measuring symptom burden and health-related quality of life in dialysis patients: first results from the Dutch registry of patient-reported outcome measures. Clin Kidney J 14(6):1535–1544
    1. Weisbord SD, Bossola M, Fried LF, Giungi S, Tazza L, Palevsky PM, et al. Cultural comparison of symptoms in patients on maintenance hemodialysis. Hemodial Int. 2008;12(4):434–440. doi: 10.1111/j.1542-4758.2008.00307.x.
    1. Weisbord SD, Fried LF, Unruh ML, Kimmel PL, Switzer GE, Fine MJ, et al. Associations of race with depression and symptoms in patients on maintenance haemodialysis. Nephrol Dial Transpl. 2007;22(1):203–208. doi: 10.1093/ndt/gfl521.
    1. Fan G, Filipczak L, Chow E. Symptom clusters in cancer patients: a review of the literature. Curr Oncol. 2007;14(5):173–179. doi: 10.3747/co.2007.145.
    1. Kalantar SS, You AS, Norris KC, Nakata T, Novoa A, Juarez K, et al. The impact of race and ethnicity upon health-related quality of life and mortality in dialysis patients. Kidney Med. 2019;1(5):253–262. doi: 10.1016/j.xkme.2019.07.005.
    1. Narasaki Y, Okuda Y, Kalantar SS, You AS, Novoa A, Nguyen T, et al. Dietary potassium intake and mortality in a prospective hemodialysis cohort. J Ren Nutr. 2021;31(4):411–420. doi: 10.1053/j.jrn.2020.05.008.
    1. Rhee CM, Nguyen DV, Moradi H, Brunelli SM, Dukkipati R, Jing J, et al. Association of adiponectin with body composition and mortality in hemodialysis patients. Am J Kidney Dis. 2015;66(2):313–321. doi: 10.1053/j.ajkd.2015.02.325.
    1. You AS, Kalantar-Zadeh K, Obi Y, Novoa A, Peralta RA, Streja E, et al. Residual urine output and mortality in a prospective hemodialysis cohort. Kidney Int Rep. 2020;5(5):643–653. doi: 10.1016/j.ekir.2020.02.002.
    1. Eneanya ND, Wenger JB, Waite K, Crittenden S, Hazar DB, Volandes A, et al. Racial disparities in end-of-life communication and preferences among chronic kidney disease patients. Am J Nephrol. 2016;44(1):46–53. doi: 10.1159/000447097.
    1. Plantinga LC, Drenkard C, Patzer RE, Klein M, Kramer MR, Pastan S, et al. Sociodemographic and geographic predictors of quality of care in United States patients with end-stage renal disease due to lupus nephritis. Arthritis Rheumatol. 2015;67(3):761–772. doi: 10.1002/art.38983.
    1. Rhee CM, Lertdumrongluk P, Streja E, Park J, Moradi H, Lau WL, et al. Impact of age, race and ethnicity on dialysis patient survival and kidney transplantation disparities. Am J Nephrol. 2014;39(3):183–194. doi: 10.1159/000358497.
    1. Rhee CM, Obi Y, Mathew AT, Kalantar-Zadeh K. Precision medicine in the transition to dialysis and personalized renal replacement therapy. Semin Nephrol. 2018;38(4):325–335. doi: 10.1016/j.semnephrol.2018.05.003.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir