SYMPTOM CLUSTERS IN HEMODIALYSIS PATIENTS AND QUALITY OF LIFE

SYMPTOM CLUSTERS IN HEMODIALYSIS PATIENTS AND QUALITY OF LIFE

Symptom burden is high in hemodialysis (HD) population. HD patients may suffer from many symptoms simultaneously with worsening their quality of life (QoL), treatment compliance as well as it linked with mortality. Clinical practice guidelines include the symptoms improving as a key element of care. Correction of symptoms is hindered by their diversity and lack of evidence of its correction importance for hard outcomes achieving. The large number of concurrent symptoms make it difficult to assess each symptom singly. Consolidating the symptoms in presumably related group can facilitate the results achievement.

Ninety-eight patients fully completed Dialysis Symptom Index (DSI) and QoL surveys. The DSI consists of 30 symptoms that are common for HD; for each symptom, patients reported to what extent they have been bothered by it on a scale from 1 (not at all) to 5 (extremely). QoL were assessed by KDQoL-36 during the same week; we used Physical Composite Summary (PCS) and Mental Composite Summary (MCS) as the outcome measures.

Рatients were 55±17 yo, female – 48%, dialysis vintage 26; 23÷84 months. The most frequent PRD: glomerulonephritis 27%, diabetes 18%, hypertension and vascular nephropathy 14%, interstitial diseases 13%, polycystic disease 10%. The dialysis schedule: 4-4.5 hours trice a week. The most common symptoms were Feeling tired (66%), Trouble falling asleep (56%), Trouble staying asleep (52%), Restress legs (50%), Numbness (50%), Worrying (50%), while gastrointestinal symptoms (Vomiting (9%), Constipation (16%), Nausea (20%), Diarrhea (26%) and Decreased appetite (29%)) patients reported in <30% cases. Each patient suffered from 12, 6÷16 symptoms. The most bothering: Feeling tired, Restless legs, (median for both 2; 1÷3), Trouble falling asleep and Trouble staying asleep (for both 2; 2÷4), Headache, Bone or joint pain and Cough (for all 2; 1÷3). Only 4 patients reported no symptoms. The median for individual DSI was 1,74; 1,29÷2,07; each patient reported about 12; 6÷16 symptoms.

Four clusters were identified in factorial analysis (Table 1).

Across all clusters, the unadjusted and adjusted models showed a significant association between cluster symptom scores and quality of life. Our study identified symptom clusters related to Mental health, Body health, Sex limitations, Gastrointestinal symptoms. The study results provide directions for potentially more effective cluster approach to the correction of symptoms, responding to the recommendations for a more patient-centered approach.