Abstract
BackgroundDialysis is a life-sustaining treatment, but many patients suffer symptoms during dialysis and take time to recover. Previous reports have linked recovery time to intra-dialytic hypotension and rapid solute clearances, whereas others have reported an association with psychological factors. As such, we wished to investigate which factors were important in determining symptom self-reporting and delayed recovery times.MethodsWe recorded self-reported patient intra-dialytic symptoms, recovery times along with sessional dialysis prescriptions, blood pressure and urea clearance, and distress thermometer scores to assess psychological factors.FindingsSix hundred twenty-three dialysis patients were studied; 621 treated by haemodiafiltration, 60.8% male, mean age 64.5 ± 16.2 years, and 46.1% diabetic. Almost half (49.6%) reported recovery within 1 h. On multivariate analysis, patient self-reported symptom scores were associated with longer post-dialysis recovery times (odds ratio (OR) 1.61, 95% confidence limits (CL) 1.33–1.95), higher distress thermometer scores (OR 1.3 CL (1.3–1.39), but lower hand grip strength (OR 0.85 CL (0.93–0.94), all p < 0.001, and younger rather than older patients (OR 0.98 CL (0.97–0.99) p = 0.005. We found no association with ultrafiltration rates or weight loss.DiscussionCompared to earlier studies, our patients treated by haemodiafiltration reported fewer symptoms and shorter recovery times. Patients with higher self-reported distress thermometer scores had both longer post-dialysis recovery times and greater dialysis symptom scores. Younger patients reported more dialysis symptoms and longer recovery times than older patients. Future studies investigating patient self-reported recovery times and dialysis-associated symptoms should also consider interventions to reduce patient psychological factors as well as dialysis practices.
Highlights
Haemodialysis is a life-sustaining treatment for patients with end-stage kidney disease
Patients and methods As part of UK National Health Service guidelines to request patient feedback on treatment received, all patients attending for routine outpatient dialysis treatments under the care of a university hospital were asked to complete a questionnaire recording the frequency of dialysis-associated symptoms and time to recovery using a previously reported visual analogue scale [4, 14], and a distress thermometer score, a screening tool for assessing psychological stress [19]
Six hundred fifty-three adult outpatients attended for dialysis out of a possible 668, with 15 patients absent either admitted to hospital or on-holiday, and 623 (95.4%) completed the dialysis symptom and distress thermometer questionnaire
Summary
Haemodialysis is a life-sustaining treatment for patients with end-stage kidney disease. Blood pressure may fall along with perfusion to internal organs, with hypotension being the most commonly reported complication of routine outpatient dialysis treatments [6]. Previous reports have linked various aspects of the dialysis prescription with intra-dialytic and post-dialysis symptom reporting, including the choice of dialysate sodium, potassium and temperature [7,8,9]. Whereas others have reported that the prevalence of intra-dialysis symptoms and post-dialysis fatigue is reduced by achieving greater urea clearance [10], or by changing from the standard thrice weekly dialysis schedule to shorter but more frequent. Dialysis is a life-sustaining treatment, but many patients suffer symptoms during dialysis and take time to recover. Previous reports have linked recovery time to intra-dialytic hypotension and rapid solute clearances, whereas others have reported an association with psychological factors. We wished to investigate which factors were important in determining symptom self-reporting and delayed recovery times
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