Patient-reported gastrointestinal symptoms in patients with peritoneal dialysis: the prevalence, influence factors and association with quality of life

Chen, Yi; Wang, Xin; Ye, Hongjian; Lin, Jianxiong; Yang, Xiao

doi:10.1186/s12882-022-02723-9

Cited by 14 publications

(12 citation statements)

References 25 publications

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“…Most patients receiving PD experience gastrointestinal symptoms, including constipation (14.2–0.3%), indigestion (32.7%), early satiety (41.6%) and gastroesophageal reflux (30.7–93.1%) 117 . Compared with patients receiving HD, constipation is less common among patients treated with PD owing to higher dietary fibre and potassium intake, more liberal fluid consumption, more active lifestyle and lower use of phosphate binders and ion exchange resins 118 – 120 . Nonetheless, constipation is associated with higher risks of catheter malfunction, peritonitis and technique failure, which demands a proactive treatment approach 118 .…”

Section: Global Patient-reported Pd Outcomesmentioning

confidence: 99%

Epidemiology of peritoneal dialysis outcomes

et al. 2022

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Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.

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Section: Global Patient-reported Pd Outcomesmentioning

confidence: 99%

Epidemiology of peritoneal dialysis outcomes

et al. 2022

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“…In the current study, we investigated various measures of constipation and their relationship with QoL in an Australian cohort of PwP and found that sufering from constipation was signifcantly associated with a reduced QoL as measured with the PDQ-39 instrument. We went on to further explore the relationship between other gastrointestinal symptoms and QoL using the comprehensive Gastrointestinal Symptom Rating Scale (GSRS), which has previously been used to evaluate the frequency and severity of gastrointestinal symptoms in assorted clinical settings [32,[34][35][36][37][38][39][40][41][42][43][44][45], but not in a QoL study in PwP. Our fndings confrmed that, in addition to constipation and other symptoms of gastrointestinal hypomotility, a number of other gastrointestinal symptoms that are not included in current clinical assessment protocols also had a negative impact on QoL.…”

Section: Discussionmentioning

confidence: 99%

Impact of Gastrointestinal Symptoms on Health-Related Quality of Life in an Australian Parkinson’s Disease Cohort

Kenna

Bakeberg

Abonnel

et al. 2022

Parkinson's Disease

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Background. Gastrointestinal symptoms (GIS) in people with Parkinson’s disease (PwP) are often underreported and may remain untreated. Constipation is a common nonmotor symptom that can adversely affect health-related quality of life (QoL); however, the impact of other GIS has not been adequately investigated. Objectives. To investigate the relationship between QoL and constipation using the Bristol Stool Chart, bowel movement frequency, and a perceived constipation measure; and to explore the relationship between QoL and other GIS in an Australian PD cohort. Methods. The impact of constipation and other GIS on QoL, as measured using the PDQ-39 scale, was assessed in a cohort of 144 (89 males, 55 females) clinic-attending PwP. Constipation was assessed using the Bristol Stool Chart as well as a composite constipation measure, and the Gastrointestinal Symptom Rating Scale (GSRS) was used to rate other GIS. Covariate corrected linear regression models were utilised to determine significant associations between GIS and QoL scores. Results. Individual and combined constipation measures were significantly associated with poorer QoL ( p = 0.032 and p = 0.002 , respectively). Analysis of GSRS symptom domains showed that in addition to symptoms of gastrointestinal hypomotility, a number of other symptoms such as increased eructation and increased flatus were also associated with poorer QoL. Conclusions. The findings point to the importance of GIS as contributor to health-related QoL in PwP. A better understanding of the relationship between GIS and QoL will help facilitate the development of more effective screening and treatment programs to improve symptom management and QoL for PwP.

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“…12,18,27,28 The risk factors associated with the severity of GI symptoms include higher glycosylated haemoglobin, higher depression score, higher daily pill intake, lower urine output and lower diastolic blood pressure. 27 In addition, higher dyspepsia and eating dysfunction scores have been found to be independently associated with lower scores on the physical component scale and QOL. 27 In this systematic review, nausea and diarrhoea were reported as the main outcomes in 27 (44%) and 26 (43%) trials, respectively, followed by vomiting in 22 (36%) trials, constipation in 21 (34%) trials and abdominal pain in 19 (31%) trials.…”

Section: Discussionmentioning

confidence: 99%

“…Besides the accompanying physical distress, GI symptoms are also associated with psychosomatic problems such as anxiety, headache, insomnia, depression and poor QOL in patients receiving dialysis. 19,20,27,28 Furthermore, GI symptoms have been reported to be negatively associated with psychosocial well-being in kidney failure patients. Dyspepsia, eating dysfunction and constipation are independently associated with depression and worse physical well-being and QOL in dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

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Range and consistency of gastrointestinal outcomes reported in peritoneal dialysis trials: A systematic review

et al. 2022

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Background: Gastrointestinal (GI) health is considered vital to the success of peritoneal dialysis (PD) and is critically important to patients, caregivers and clinicians. However, the multiplicity of GI outcome measures in trials undermines the ability to evaluate the frequency, impact and treatment of GI symptoms in patients receiving PD. Therefore, this study aimed to assess the range and consistency of GI outcomes reported in contemporary PD trials. Study design: Systematic review. Setting and population: Individuals with kidney failure requiring PD. Selection criteria: All randomised controlled trials involving patients on PD, identified from the PUBMED, EMBASE and COCHRANE Central Registry of controlled Trials (CENTRAL) database, from January 2010 to July 2022. Interventions: Any PD-related intervention. Outcomes: The frequency and characteristics of GI outcome measures were analysed and classified. Results: Of the 324 eligible PD trials, GI outcomes were only reported in 61 (19%) trials, mostly as patient-reported outcomes (45 trials; 74%). The most frequently reported outcomes were nausea in 27 (43%), diarrhoea in 26 (43%), vomiting in 22 (36%), constipation in 21 (34%) and abdominal pain in 19 (31%) of trials. PD peritonitis was the primary non-GI outcome reported in 24 (40%) trials, followed by death in 13 (21%) trials) and exit-site infection in 9 (15%) trials). Across all trials, 172 GI outcome measures were extracted and grouped into 29 different outcomes. Nausea and diarrhoea contributed to 16% and 15% of GI outcomes, respectively, while vomiting, constipation and abdominal pain contributed to 13%, 12% and 12%, respectively. Most (90%) GI outcomes were patient-reported adverse effects with no defined metrics. Faecal microbiome was reported as the primary study outcome in 3 (100%) trials using the subjective global assessment score, GI symptom rating scale and faecal microbiological and biochemical analysis. Two trials reported nausea as a primary study outcome using symptom assessment score (SAS) and kidney disease quality of life-short-form-36. One trial each reported anorexia and abdominal pain as the primary study outcome using SAS. Bowel habits, constipation and stool type were also reported as the primary study outcome in one trial each using the Bristol stool form scale. GI bleeding was reported as the secondary outcome in three (37%) out of eight trials reporting it. Limitations: Restricted sampling frame to focus on contemporary trials. Conclusions: Despite the clinical importance of GI outcomes among patients on PD, they are reported in only 19% of PD trials, using inconsistent metrics, often as patient-reported adverse events. Efforts to standardise GI outcome reporting are critical to optimising comparability, reliability and value of trial evidence to improve outcomes for patients receiving PD.

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Patient-reported gastrointestinal symptoms in patients with peritoneal dialysis: the prevalence, influence factors and association with quality of life

Cited by 14 publications

References 25 publications

Epidemiology of peritoneal dialysis outcomes

Epidemiology of peritoneal dialysis outcomes

Impact of Gastrointestinal Symptoms on Health-Related Quality of Life in an Australian Parkinson’s Disease Cohort

Range and consistency of gastrointestinal outcomes reported in peritoneal dialysis trials: A systematic review

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