PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: Health‐Related Quality of Life in Nephrology Research and Clinical Practice

Unruh, Mark; Weisbord, Steven D.; Kimmel, Paul L.

doi:10.1111/j.1525-139x.2005.18206.x

Cited by 104 publications

(83 citation statements)

References 80 publications

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“…P atients who are on maintenance hemodialysis have impaired health-related quality of life (HRQoL) compared with the general population and patients with functioning renal transplants (1)(2)(3)(4)(5). Although multiple factors likely contribute to these impairment in HRQoL, growing evidence suggests that physical and emotional symptoms play an important role (6 -13).…”

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confidence: 99%

Renal Provider Recognition of Symptoms in Patients on Maintenance Hemodialysis

Weisbord

Fried

Mor

et al. 2007

Clinical Journal of the American Society of Nephrology

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270

220

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Background and Objectives: Although several studies have found that the burden of symptoms in patients who are on maintenance hemodialysis is substantial, little is known about renal providers' awareness of these symptoms. The aim of this study was to assess renal provider recognition of symptoms and their severity in hemodialysis patients.Design, Setting, Participants, & Measurements: The Dialysis Symptom Index, a 30-item measure of symptoms and their severity, was administered to patients during a routine hemodialysis session. Immediately after surveying patients, the renal provider who evaluated the patient completed the Dialysis Symptom Index to report the symptoms that he or she believed were present in that patient. Sensitivity, specificity, and positive and negative predictive values of provider reports of symptoms were calculated using patient reports as the reference standard. Patient-provider agreement on the presence and severity of symptoms was assessed using the statistic.Results: Surveys were completed by 75 patients and 18 providers. For 27 of 30 symptoms, the sensitivity of provider responses was <50%, and provider responses for 25 symptoms were characterized by positive predictive values of <75%. scores for 25 symptoms including those pertaining to pain, sexual dysfunction, sleep disturbance, and psychologic distress were <0.20, indicating poor provider recognition of these symptoms. Providers underestimated the severity of 19 of 30 symptoms.Conclusions: Renal providers are largely unaware of the presence and severity of symptoms in patients who are on maintenance hemodialysis. Implementation of a standardized symptom assessment process may improve provider recognition of symptoms and promote use of symptom-alleviating treatments.

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confidence: 99%

Renal Provider Recognition of Symptoms in Patients on Maintenance Hemodialysis

Weisbord

Fried

Mor

et al. 2007

Clinical Journal of the American Society of Nephrology

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270

220

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“…While life-sustaining, chronic dialysis is associated with substantial impairments in health-related quality of life (HRQoL) (1,2). The well-recognized decrements in HRQoL in patients with ESRD are likely related to multiple factors, including functional limitations, impaired social well being, vocational disruptions associated with a thrice-weekly or quotidian treatment, and a large burden of physical and emotional symptoms.…”

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confidence: 99%

Female Sexual Dysfunction in ESRD

Weisbord

2012

Clinical Journal of the American Society of Nephrology

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While life-sustaining, chronic dialysis is associated with substantial impairments in health-related quality of life (HRQoL) (1,2). The well-recognized decrements in HRQoL in patients with ESRD are likely related to multiple factors, including functional limitations, impaired social well being, vocational disruptions associated with a thrice-weekly or quotidian treatment, and a large burden of physical and emotional symptoms. Specific symptoms that occur with regularity in patients on chronic dialysis are fatigue, cramping, pain, and dyspnea (3,4). Another symptom that appears to occur frequently in patients with ESRD is sexual dysfunction, etiologies for which include hormonal dysregulation, vascular disease, autonomic dysfunction, medication side effects, and psychologic illness such as depression (5,6).To date, the preponderance of research on sexual dysfunction in patients with ESRD has focused on men. Although there are several domains of male sexual function that may be impaired, the most frequently studied has been erectile dysfunction (ED), in part because of the availability of efficacious pharmacological therapy (7,8). Multiple studies have documented ED to be highly prevalent and strongly correlated with HRQoL in men on chronic dialysis and have identified the clinical predictors of this symptom (9,10). In a comprehensive cross-sectional study of 302 communitybased male hemodialysis patients, Rosas et al. (9,11) found that ED was present in 82%, was severe in 45%, and was associated with impairments in multiple domains of HRQoL. A subsequent study by Türk et al. (10) demonstrated that ED was present in 104 (70%) of 148 patients on chronic hemodialysis and was closely correlated with decrements in physical and mental well being. Older age and diabetes were associated with ED in both of these studies. Data from these and other studies, which collectively enrolled thousands of patients, confirm the high prevalence and clinical importance of ED in men on dialysis and inform our understanding of factors that help predict the presence of this symptom.Although women comprise approximately one-half of all patients with ESRD, considerably less attention has been paid to female sexual dysfunction in this population. A series of small past studies suggest that sexual dysfunction is common among women receiving chronic dialysis. Yazici et al. (12) studied 117 women with ESRD and found that sexual dysfunction was present in 94% of patients on peritoneal dialysis and 100% of those on hemodialysis. More recently, Seethala et al. (13) found impairments in multiple domains of sexual function in 66 female patients on chronic dialysis and high rates of sexual dysfunction among women with partners and those who reported to be sexually active. Notwithstanding these findings, studies investigating this issue were limited by the enrollment of small numbers of patients and the lack of statistical power to elucidate which clinical factors are associated with and predict the presence of sexual dysfunction.In an effort to br...

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“…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).…”

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confidence: 99%

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

Abdel-Kader

Unruh²,

Weisbord³

2009

Clinical Journal of the American Society of Nephrology

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412

378

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Background and objectives: While many patients with end-stage renal disease (ESRD) have impaired physical and psychologic well-being, less is known about these health domains in patients with advanced chronic kidney disease (CKD). The authors sought to compare symptoms, depression, and quality of life in patients with ESRD and those with CKD.Design, setting, participants, & measurements: Patients with ESRD and subjects with advanced CKD were enrolled. Patients' symptoms, depression, and quality of life were assessed using the Dialysis Symptom Index (DSI), Patient Health Questionnaire-9 (PHQ-9), and Short Form 36 (SF-36), respectively, and these health domains were compared between patient groups.Results: Ninety patients with ESRD and 87 with CKD were enrolled. There were no differences in the overall number of symptoms or in the total DSI symptom-severity score. Median scores on the PHQ-9 were similar, as was the proportion of patients with PHQ-9 scores >9. SF-36 Physical Component Summary scores were comparable, as were SF-36 Mental Component Summary scores.Conclusions: The burden of symptoms, prevalence of depression, and low quality of life are comparable in patients with ESRD and advanced CKD. Given the widely recognized impairments in these domains in ESRD, findings of this study underscore the substantial decrements in the physical and psychologic well-being of patients with CKD.

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PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: Health‐Related Quality of Life in Nephrology Research and Clinical Practice

Cited by 104 publications

References 80 publications

Renal Provider Recognition of Symptoms in Patients on Maintenance Hemodialysis

Renal Provider Recognition of Symptoms in Patients on Maintenance Hemodialysis

Female Sexual Dysfunction in ESRD

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

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