P0833SYMPTOM BURDEN IN CHRONIC KIDNEY DISEASE : A CASE FOR STARTING KIDNEY SUPPORTIVE CARE CLINIC

Abstract

Abstract Background and Aims Chronic Kidney Disease(CKD) is associated with a huge symptom burden which increases with progression and leads to depreciation in Quality of life both directly and indirectly through effects on functional status, health perception, and feelings of subjective well-being. Dialysis therapy does not completely improve symptoms. We studied supportive care needs of patients with CKD through assessment of symptoms using translated version of Integrated Palliative Care Outcome Scale (IPOS- Renal) in a single tertiary health setting. Method Patients with chronic Kidney disease having creatinine clearance less than 60 ml/min/m2 were surveyed using IPOS Renal modified translated to vernacular language by forward- backward method. Translated version was approved by independent translator. Symptoms were classified into domains and analyzed using descriptive statistics. Scores were compared for those on maintenance hemodialysis with predialysis CKD patients. Results Of 184 patients, 128(69.6%) were receiving twice weekly hemodialysis, mean age was 52 years (range 20-82 year), 140(76%) were male. Average duration of dialysis was 4 years, 87 (46.9%) reported pain of which 39/87(45%) had moderate to severe pain. Other symptoms over past one week were dyspnea in 59(33.6%), Fatigue in 117(69.4%), Nausea in 53(33.6%), Vomiting in 36(20.9%), Anorexia in 90(42.4%), Constipation in 50(35.3%), Dry mouth/soreness in 62(36.4%), increased drowsiness in 63(46.6%), poor mobility in 87(55.8%), Itching in 69(39.3%), Disturbed sleep in 83(48.6%), Restless leg in75(43.6%), Skin related problems in 47(28.6%). Five patients reported presence of other severe symptoms. In Psychosocial domain 138(79.8%) patients and 126(72.8 %) family members expressed anxiety related to their disease or treatment of which one third had persistent anxiety, 140(81.6%) felt depressed and among them 58(42%) felt it most of the time or always and 145(88.6%) felt that they were not at peace, 59(35%) felt they did not have enough information about their disease and treatment and 79(47%) reported that they had unaddressed financial or personal problems, 124(77.2 %) felt they had to spend significant amount of time in healthcare facility. Patients on dialysis had significantly higher symptoms burden and Psychosocial needs. Conclusion CKD patients face high physical and psychosocial burden which is unaddressed in present clinical care and increases with stage. Tools such as iPOS renal are required to assess need of supportive care in CKD. Kidney supportive care clinic may be required to address this unmet need.