Clinical Features and Severity of Nonspecific Symptoms in Dialysis Patients

Abstract

Nonspecific symptoms are common in dialysis patients but few methods are available to measure their severity and their response to alteration in dialysis therapy. To determine the clinical features and measure the severity of the most important symptoms in end-stage renal disease (ESRD) patients, 97 dialysis patients were interviewed, 63 of whom were reinterviewed 1 year later. For comparison 82 transplant recipients were also interviewed. The six most important symptoms in dialysis patients (using the product of the patient’s perception of severity and prevalence) were tiredness, cramps, pruritus, dyspnea, headaches and joint pain. The symptoms were long-standing, occurred frequently, with little difference in prevalence between hemo- and peritoneal dialysis patients, and were often unrelated to a hemodialysis session. For each symptom, several dimensions of severity were assessed including frequency, duration, effect on sleep, daily living, activity, subjective quality of life and necessity for drug therapy. Often these dimensions did not correlate with patient’s perception of severity. For each symptom these items were combined to give an aggregate score with a range 0–10. Interobserver reproducibility for each symptom score was > 0.7 but intraobserver reproducibility was poor for 3 symptoms, because of the fluctuating nature of the symptoms. Construct validity was demonstrated by finding a significantly worse distribution of aggregate scores for tiredness, cramps, pruritus, dyspnea and nausea/vomiting in dialysis compared to transplant patients. Aggregate scores changed little after 1 year’s follow-up in stable dialysis patients but significant improvement in the aggregate scores for tiredness, dyspnea and nausea/vomiting were observed in 14 patients after successful transplantation. Multi-dimensional aggregate scores for individual symptoms should be useful in comparing the efficacy of various dialysis regimes and in determining the etiology of different symptoms, provided account is taken of the fluctuating nature of some of these symptoms.

Symptom Burden, Depression, and Quality of Life in Chronic and End-Stage Kidney Disease

“…P atients with end-stage renal disease (ESRD) receiving maintenance dialysis suffer from a multitude of physical and emotional symptoms, exhibit a particularly high prevalence of depression, and experience substantial impairments in quality of life (QOL) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Symptoms including fatigue, pain, muscle cramps, difficulty with sleep, and sexual dysfunction affect half or more of patients receiving chronic dialysis (12)(13)(14)(15).…”

Correlates and Outcomes of Fatigue among Incident Dialysis Patients

“…Fatigue, which can be conceptualized on a continuum from extreme tiredness to high energy (1,2), has been reported to affect 60% to 97% of chronic dialysis patients (3)(4)(5)(6)(7)(8). Fatigue is important to patients, as 94% of surveyed dialysis patients would accept more frequent hemodialysis if it would increase their energy, whereas only 19% would exchange more frequent treatments for a 3-yr increase in survival (7).…”

Elucidating Issues Stressful for Patients in Predialysis and Dialysis

“…The importance of symptoms in kidney disease has been highlighted by Parfrey, Vavasour, Henry, Bullock and Gault (1988), Weisbord, Fried, Arnold, Rotondi, Fine, Levenson and Switzer (2004), and Unruh et al (2005), for example. Parfrey et al (1988) listed tiredness, cramps, pruritus, dyspnea, headaches and joint pain as the six most important symptoms in dialysis patients, finding little difference in the prevalence of these symptoms between hemo-and peritoneal dialysis patients.…”

“…Parfrey et al (1988) listed tiredness, cramps, pruritus, dyspnea, headaches and joint pain as the six most important symptoms in dialysis patients, finding little difference in the prevalence of these symptoms between hemo-and peritoneal dialysis patients. All six symptoms were included in our list.…”

“…Further studies are needed to explore more fully what possible differences there are between patients on hemodialysis and on peritoneal dialysis in the prevalence of symptoms, although one should note that Parfrey et al (1988) found little difference between these two groups in the prevalence of the most important symptoms that they noted in their patients. Also, in Sweden, the guiding principles for the care of nephrology patients consider hemodialysis and peritoneal dialysis to be integrated parts of an optimal treatment of chronic renal failure (Svensk Njurmedicinsk Förening, 2000).…”