Clinical and Psychological Correlates of Somatic Symptoms in Patients on Dialysis

Abstract

Somatic symptoms are common in patients on dialysis. Their causes are largely unknown and their therapy is unsatisfactory. To examine the relationship of psychological and clinical factors to these symptoms, 191 interviews were done in patients on hemo- and peritoneal dialysis. The severity of 8 somatic symptoms (tiredness, sleep disturbance, cramps, pruritus, headache, nausea, dyspnea, joint pain) of importance in dialysis patients was measured using previously validated scales. Indices of affect and quality of life were obtained, as was demographic, clinical and laboratory information. The severity of each symptom was significantly related to the indices of affect and quality of life. Using multiple logistic regression, poor affect score was the strongest correlate of each of the following somatic symptoms, tiredness, pruritus, sleep disturbance and cramps. It was ahead of any clinical or demographic variable and was also significantly correlated with the severity of the other smptoms. Indices of hyperparathyroidism were significantly associated with headache, joint pain, dyspnea and nausea. We conclude that the strongest correlate of common somatic symptoms in dialysis patients is affect disturbance, and that therapy aimed at improving the affect may improve the symptoms.

Longitudinal validation of a modified Edmonton symptom assessment system (ESAS) in haemodialysis patients

“…As with the cross-sectional validity of the modified ESAS in dialysis patients [9], we again noted a lack of significant association between various clinical parameters and measures of HRQL, reinforcing the relative importance from a patient perspective of pain and other distressing symptoms to their assessment of HRQL. This is consistent with a growing body of literature in ESRD, where various demographic and biochemical variables have not demonstrated clinically meaningful associations between either symptom burden [27][28][29] or HRQL [7,8,[10][11][12][13]. It is therefore essential to systematically gather patient-reported outcomes to fully evaluate our interventions.…”

Correlates of Sleep Behavior among Hemodialysis Patients

“…Sleep disturbances among dialysis patients are found to be related to duration of dialysis therapy, high levels of urea and/or creatinine, pain, disability, and somatic complaints such as pruritus and bone pain [12,14,17,18]. Although numerous publications have described various aspects of sleep disturbance in treated ESRD patients, many are limited by small sample sizes [12,19]. Furthermore, most do not examine sleep behavior in the 1 Incident cases of ESRD are defined as patients completing a baseline interview within 6 months of starting dialysis; prevalent cases are defined as patients receiving their baseline interview after 6 months of starting dialysis.…”

“…Noted exceptions include Barrett et al [19], Bremer et al [5], and Kutner et al [20]. Barrett et al [19] found that affect (sadness, anger, helplessness, etc.) in dialysis patients was significantly related to sleep disturbances.…”

κ-Opioid System in Uremic Pruritus

“…It is, of itself, not a life-threatening condition; however, it is known to contribute to an increase in morbidity (6) and mortality (7) of uremic patients. The only current definitive treatment for uremic pruritus is successful renal transplantation (8).…”