Symptom Cluster Science in Chronic Kidney Disease: A Literature Review

Abstract

The purpose of this review was to synthesize evidence on symptom clusters in patients with chronic kidney disease (CKD). The quality of studies was evaluated using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Twelve articles met inclusion criteria. Patients had CKD ranging from Stages 2 through 5. Most studies determined clusters using variable-centered approaches based on symptoms; however, one used a person-centered approach based on demographic and clinical characteristics. The number of clusters identified ranged from two to five. Several clusters were prominent across studies including symptom dimensions of fatigue/energy/sleep, neuromuscular/pain, gastrointestinal, skin, and uremia; however, individual symptoms assigned to clusters varied widely. Several clusters correlated with patient outcomes, including health-related quality of life and mortality. Identifying symptom clusters in CKD is a nascent field, and more research is needed on symptom measures and statistical methods for clustering. The clinical implications of symptom clusters remain unclear.

Physical Symptom Cluster Subgroups in Chronic Kidney Disease

“…Variable-centered approaches to clustering, which seek to identify relationships among symptoms and quantify the patient's symptom experience, have been employed in patients with ESRD (Amro et al, 2015;Yu, Huang, & Tsai, 2012). Fatigue (Jhamb et al, 2013;Rodrigue et al, 2011), sleep disturbance (Nigam, Camacho, Chang, & Riaz, 2018), depression/anxiety (Assari & Burgard, 2015), pain (Song, Paul, Ward, Gilet, & Hladik, 2018), and gastrointestinal symptoms (Zhang, Bansal, Go, & Hsu, 2015) are among the most common co-occurring symptoms in CKD (Lockwood et al, 2019). Although variable center approaches are useful in examining relationships among homogeneous populations (Conley, 2017), variable-centered approaches to clustering symptoms are complicated by difficulty interpreting symptom clusters due to heterogeneity of symptom response patterns, thereby limiting their clinical utility (Conley, 2017;Lockwood et al, 2019;Ryan et al, 2019).…”

Burden of living with multiple concurrent symptoms in patients with end‐stage renal disease

“…A review reported that patients on dialysis experienced 6–20 symptoms (Almutary et al., 2013). In addition, several studies found that these symptoms co‐occurred in specific patterns and formed clusters (Cao, Tian, & Lin, 2017; Lockwood et al., 2018). A symptom cluster can be defined as a group of two or more symptoms that occur together and share inter‐relationships (Kim, McGuire, Tulman, & Barsevick, 2005).…”

Symptom Clusters: Is the Sum Greater Than the Parts?

“…Western Journal of Nursing Research 41(7) synthesize the data while considering the clinical implications of the findings, especially when using person-centered analyses. Lockwood et al (2019) conducted a systematic review of symptom clusters in patients with CKD. Results indicated that the number of clusters varied from two to five across studies, there were similarities in clusters across studies, and individual symptoms comprising a cluster varied widely.…”

“…In this issue of the Western Journal of Nursing Research , Ryan et al (2019) and Lockwood et al (2019) help to propel the science of symptom clusters forward through different approaches: one a multimethod statistical analysis of symptom clusters in patients with acute coronary syndrome (ACS) and the other a systematic review of symptom clusters in individuals with chronic kidney disease (CKD). Ryan et al (2019) confirmed that there were few, yet critical, differences in how symptoms clustered using both variable-centered and person-centered methods.…”

“…Lockwood et al (2019) conducted a systematic review of symptom clusters in patients with CKD. Results indicated that the number of clusters varied from two to five across studies, there were similarities in clusters across studies, and individual symptoms comprising a cluster varied widely.…”