Abstract
BackgroundQuality of life for haemodialysis (HD) patients may be affected by symptoms during dialysis treatments, and patient groups have highlighted the need to improve post-dialysis fatigue and dialysis-related symptoms. As changes in extracellular water (ECW) may lead to cramps and other symptoms, we wished to determine whether there was an association between ECW and intra-dialytic symptoms.MethodsWe reviewed the hospital records of HD patients who completed a self-reported intra-dialytic symptom questionnaire, using a visual analogue scale, who had contemporaneous pre- and postdialysis bioimpedance ECW measurements adjusted to height (aECW).ResultsWe studied dialysis sessions of 506 patients, 314 (62.1%) male, 226 (44.7%) diabetic, mean age 64.6 ± 15.7 years, weight 69.9 ± 17.4 kg, and duration of dialysis treatment 26 (9.6–60.1) months. We divided patients into three groups according to pre-dialysis aECW, and total dialysis symptom scores were greater for those in the lower tertile (25 (10–41) vs middle 18 (8.5–34) vs upper 20 (7–31), p < 0.05). Only feeling cold, dizziness, and low blood pressure were statistically different between the three pre-dialysis aECW groups, and there was no difference in post-dialysis recovery times.We analysed the effect of the fall in aECW pre-to post-dialysis. Patients in the group with the greatest fall in aECW did not report more intra-dialytic symptoms or longer recovery times.ConclusionWe found that patients starting dialysis with lower relative ECW were more likely to report intra-dialytic symptoms than those with greater amounts of fluid to remove, and most commonly reported symptoms were associated with intra-vascular volume depletion.
Highlights
More than 2 million patients with chronic kidney disease (CKD) are treated by haemodialysis world-wide
Patients and methods In keeping with UK National Health Service (NHS) guidelines to obtain patient feedback on treatment, we asked all patients attending for outpatient dialysis treatment in 3 dialysis centres 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 [10, 15], 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, July, and November 2017, respectively
When comparing individual symptom scores, only feeling cold, dizziness and low blood pressure were statistically greater for the lower pre-dialysis adjusted ECW by height (aECW) group compared to the middle and upper aECW groups (Table 2), and there was no difference in post-dialysis recovery times (Fig. 2), or recorded blood pressure (Table 1)
Summary
More than 2 million patients with chronic kidney disease (CKD) are treated by haemodialysis world-wide. Haemodialysis patients experience poor health-related quality of life [4] and self-report high levels of depression [5]. Along with other dialysis stakeholders, have identified symptom relief as a top priority and have called for increased symptom focus in both research and clinical practice [6,7,8]. Symptoms, such as fatigue, may be a consequence of CKD or directly attributable to the haemodialysis treatments [9], and several centres have developed haemodialysis-specific symptom questionnaires [10, 11]. As changes in extracellular water (ECW) may lead to cramps and other symptoms, we wished to determine whether there was an association between ECW and intra-dialytic symptoms
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