Abstract
BackgroundHaemodialysis (HD) patients may suffer symptoms during dialysis and take time to recover post HD. We wished to determine whether patients with symptomatic intra-dialytic hypotension (IDH), requiring nursing interventions, or an asymptomatic fall in systolic blood pressure (SBP) reported more symptoms during dialysis.MethodsSix hundred three HD patients completed self-reported intra-dialytic symptom questionnaires and recovery using a visual analogue scale, which were compared with their dialysis session records.ResultsTwenty-nine (4.8%) of patients suffered symptomatic IDH, and 187 (31.0%) had a fall in SBP of > 20 mmHg. Symptomatic patients had greater total symptom scores (30 (23–44) vs 23 (10–38), p < 0.05, versus asymptomatic patients, with increased low blood pressure, dizziness, cramps, palpitations and feeling cold reported (all p < 0.05). Patients with a SBP fall of > 20 mmHg had greater total scores compared with those with a SBP increase of > 10 mmHg (26 (13–38) vs 17 (7–34), p < 0.05), with more dizziness, cramps, backache, shortness of breath and headache reported (all p < 0.05). Although ultrafiltration rates were similar, HD weight loss was greater for patients with a SBP fall of > 20 mmHg (2.5 ± 1.1 vs 2.0 ± 1.3%, p < 0.05). Patients with highest symptoms scores (highest vs lowest quartile) had longer recovery times (40.3 vs 7.6% > 4 h), p < 0.001.Multivariable analysis showed that patients reporting more intradialytic symptoms had higher psychological distress thermometer scores (odds ratio (OR) 1.34 (95% confidence limits 1.26–1.44)), systolic blood pressure < 100 mmHg (OR 2.53 (1.04–6.1)), whereas symptom scores were lower for male gender (OR 0.34 (0.22–0.51)), and with increasing age (OR 0.99 (0.97–0.99)).ConclusionPatients with both symptomatic and asymptomatic IDH, self-reported more symptoms during dialysis, and those patients reporting more symptoms had longer recovery times. We found that younger, female patients, those with greater psychological distress, and lower systolic blood pressure self-reported more intra-dialytic symptoms. More attention is required to prevent falls in intra-dialytic blood pressure to improve the patient experience of HD and shorten post-dialysis recovery times.
Highlights
In addition to the impact of chronic kidney disease on lifestyle and patient well-being, haemodialysis treatments themselves may cause symptoms [1,2,3,4,5]
Patients and methods In keeping with United Kingdom (UK) National Health Service (NHS) guidelines to obtain patient feedback on treatment, we asked all patients attending for outpatient dialysis treatment under the care of the Royal Free Hospital, London, to self-report the frequency of dialysis associated symptoms, including fatigue, feeling cold, cramps, dizziness, headache, nausea, abdominal pain, back ache, pruritus, short of breath and palpitations and time to recovery using a previously reported visual analogue scale [4, 11], when they attended for a routine out-patient mid-week dialysis session in four outlying satellite dialysis centres under the care of a university hospital in sequence in May, June and November 2017, respectively
Patients suffering from symptomatic intra-dialytic hypotension were more likely to be female, of lower body weight, with greater frailty scores and with more comorbidity, and started dialysis with a lower blood pressure and serum albumin (Table 1)
Summary
In addition to the impact of chronic kidney disease on lifestyle and patient well-being, haemodialysis treatments themselves may cause symptoms [1,2,3,4,5]. There has been no substantive evidence to support that dialyzer selection, dialysis modality or choice of dialysate composition significantly impact on reducing patient self-reported intra-dialytic symptoms [1]. Only a minority of patients suffer with symptomatic intra-dialytic hypotension, there is growing concern about asymptomatic intra-dialytic hypotension [10], which may lead to longer term adverse health consequences. We wished to determine whether changes in blood pressure during a haemodiafiltration session increased the frequency of patient self-reported intra-dialytic symptoms and increased postdialysis recovery times. Haemodialysis (HD) patients may suffer symptoms during dialysis and take time to recover post HD. We wished to determine whether patients with symptomatic intra-dialytic hypotension (IDH), requiring nursing interventions, or an asymptomatic fall in systolic blood pressure (SBP) reported more symptoms during dialysis
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