Symptom Management of the Patient with CKD: The Role of Dialysis

Cabrera, Valerie Jorge; Hansson, Joni H.; Kliger, Alan S.; Finkelstein, Fredric O.

doi:10.2215/cjn.01650216

Cited by 79 publications

(56 citation statements)

References 70 publications

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“…Over 1 million people will start dialysis for ESKD in the next decade (1). Although dialysis prevents death from kidney failure over the short term, many patients continue to suffer from uremic symptoms including anorexia, nausea, pruritus, fatigue, excessive daytime sleepiness, difficulty concentrating, and pain (2). Uremic symptoms are a major contributor to the poor health-related quality of life experienced by patients on dialysis, which is often a greater concern than survival for these patients.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Persistence of Uremic Symptoms in Incident Dialysis Patients

et al. 2020

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Background Uremic symptoms are major contributors to the poor quality of life among patients on dialysis, but whether their prevalence or intensity has changed over time is unknown. Methods We examined responses to validated questionnaires in two incident dialysis cohort studies, the Choices for Health Outcomes in Caring for ESRD (CHOICE) study (N5926, 1995-1998) and the Longitudinal United States/Canada Incident Dialysis (LUCID) study (N5428, 2011-2017). We determined the prevalence and severity of uremic symptoms-anorexia, nausea/vomiting, pruritus, sleepiness, difficulty concentrating, fatigue, and pain-in both cohorts. Results In CHOICE and LUCID, respectively, mean age of the participants was 58 and 60 years, 53% and 60% were male, and 28% and 32% were black. In both cohorts, 54% of the participants had diabetes. Median time from dialysis initiation to the symptoms questionnaires was 45 days for CHOICE and 77 days for LUCID. Uremic symptom prevalence in CHOICE did not change from baseline to 1-year follow-up and was similar across CHOICE and LUCID. Baseline symptom prevalence in CHOICE and LUCID was as follows: anorexia (44%, 44%, respectively), nausea/vomiting (36%, 43%), pruritus (72%, 63%), sleepiness (86%, 68%), difficulty concentrating (55%, 57%), fatigue (89%, 77%), and pain (82%, 79%). In both cohorts, .80% of patients had three or more symptoms and .50% had five or more symptoms. The correlation between individual symptoms was low (r,0.5 for all comparisons). In CHOICE, no clinical or laboratory parameter was strongly associated with multiple symptoms. Conclusions The burden of uremic symptoms among patients on dialysis is substantial and has not changed in the past 15 years. Improving quality of life will require identification of the factors that underlie the pathogenesis of uremic symptoms and better ways of removing the toxins that are responsible.

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Section: Introductionmentioning

confidence: 99%

Prevalence and Persistence of Uremic Symptoms in Incident Dialysis Patients

et al. 2020

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“…Among various domains of cognition, memory and attention reported to be frequently affected (9,10). The impairment in memory and attention in patients with kidney disease may be related to disturbed brain function secondary to uremic toxins, and psychological distress (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

ٍEvaluation of attention and memory function in hemodialysis patients; a study based on hemodialysis duration

et al. 2019

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Introduction: End-stage renal disease (ESRD) is one of the health problems in today's world. Neuropsychological problems are more common in hemodialysis (HD) patients than in healthy individuals. Objectives: The aim of this study was to investigate the effect of long-term HD on memory function of these patients. Patients and Methods: Our study, included 80 HD patients of whom 39 were under 6 months of HD and 41 patients as another group which had a history of HD more than 6 months. Results: The population had a mean age of 51.60 years old (27.5% female). The scores of patients who have been hemodialyzed for a long-time (median time of HD was up to 4 years) had lower score in forward digit (FD), backward digit score test (BD), letter digit modality task (LDMT), letter symbol digit modality task (LSDMT) (5.49; 3.61; 21.12; 17.66) than the HD patients who underwent HD for a shorter term, with the median time of 3 to 5 months (7.38; 4.79; 39.77; 43.38) (P < 0.001). Conclusion:The present study demonstrated that end-stage HD patients who were under HD for a long time had significantly lower scores in the memory and attention tests. However, additional researches are needed in this area. ABSTRACTImplication for health policy/practice/research/medical education: ESRD patients who were under HD for a long time had significantly lower scores in the memory and attention tests. Please cite this paper as: Alidadi A, Bakhshani NM, Sabayan B, Ansari-Moghadam A. Evaluation of attention and memory function in hemodialysis patients; a study based on hemodialysis duration. J Nephropathol. 2020;9(3):e28.

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“…The trial can allow patients to evaluate dialysis's effect on their life and also allows the nephrologist to evaluate patients' response to the treatment. An analogous approach is to incrementally increase dialysis prescription over time for patients with residual renal function that can lessen the effects of dialysis treatment on depressive symptoms due to decreased treatment burden [20]. It is also important to keep in mind that nonadherence and argumentativeness alone are never grounds for involuntary discharge.…”

Section: Dialysis Unit Staff Management Of Difficult Behaviorsmentioning

confidence: 99%

Difficult Patient Behavior in Dialysis Facilities

2018

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Difficult behavior exhibited by dialysis patients is a spectrum that includes nonadherence, verbal or physical abuse, and threatening acts. Such behaviors may lead to harmful consequences to the patient, other patients, the facility, and staff and can culminate in involuntary discharge. It is important to recognize that these “difficult behaviors” may be due to underlying psychosocial or medical issues, which places an onus on care providers to explore further. According to the Conditions for Coverage (CfC) for dialysis facilities, it falls upon the medical director to coordinate and oversee policies for patient satisfaction, patient safety and rights, involuntary discharges, and adverse events and outcomes. Thus, medical directors are liable for their own actions, and their staff for which they have oversight, for harm or perceived harm to patients in response to difficult behaviors. Guidelines to deal with specific patient behavior scenarios have been published by the Decreasing Dialysis Patient Conflict National Task Force of the Forum of end-stage renal disease (ESRD) Networks. The common denominator for these difficult scenarios is impaired communication, and the majority of patient concerns involve issues with staff, policies, treatments, and diet. Involuntary discharge of a patient should always be viewed as a last resort, and there is a structured process described in the CfC that requires the involvement of the respective ESRD Network and the facility medical director. As physicians, we are bound by ethical and growing legal obligations to act in an appropriate, ethical, and fair manner to patients who are considered to be “difficult.”

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Symptom Management of the Patient with CKD: The Role of Dialysis

Cited by 79 publications

References 70 publications

Prevalence and Persistence of Uremic Symptoms in Incident Dialysis Patients

Prevalence and Persistence of Uremic Symptoms in Incident Dialysis Patients

ٍEvaluation of attention and memory function in hemodialysis patients; a study based on hemodialysis duration

Difficult Patient Behavior in Dialysis Facilities

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