Symptom Burden in Patients on Maintenance Haemodialysis: Magnitude, Associated Factors, Patients’ attitude and Practice

Abstract

Background: Despite the enormous strides in haemodialysis technology and patient care in high-income countries, patients still experience a lot of symptoms which impair their quality of life (QoL). Data on symptom burden is lacking in low-income countries where the haemodialysis population is younger and access to care is limited. Objectives: To assess the symptom burden in patients on maintenance haemodialysis, its associated factors, patients’ attitude, and practice. Materials and Methods: All consenting patients on maintenance haemodialysis for at least 3 months in 2 referral hospitals in Yaoundé, Cameroon, were screened for symptoms. We excluded patients with dementia or those with acute illness. We used the Dialysis symptom index (DSI) and the modified Subjective Global Assessment tool to assess symptom burden and nutritional status, respectively. We analysed the data using Statistical Package for Social Science (SPSS) 26.0. A dialysis symptom index above the 75th percentile was considered a higher symptom burden. Results: we enrolled 181 participants (64.1% males) with a mean ±SD age of 46.46±14.19years. The median (IQR) dialysis vintage was 37[12-67.5] months and 37% (n=67) were on recombinant erythropoietin. All patients experienced at least a symptom with a median (IQR) of 12[8.0 – 16.0] symptoms per patient. Feeling tired/lack of energy (79%, n=143), decreased interest in sex (73.5%, n=133), dry skin (70.2%, n=127), difficulty becoming sexually aroused (62.4%, n=113), worrying (60.2%, n=109), bone/joint pain (56.4%, n=102), feeling nervous (50.8%, n=92), muscle cramps (50.8%, n=92) and dry mouth (50.3%, n=91) were the most frequent symptoms. The median (IQR) DSI severity score was 41[22.5-58.5] with 24.9% (n=45) having a higher symptom burden. Diabetes mellitus (AOR 5.50; CI 4.66-18.28, p=0.005), malnutrition (AOR 17.68; CI 3.02-103.59, p=0.001), poorly controlled diastolic blood pressure (AOR 4.19; CI 1.20-14.62, p=0.025) and less than 2 weekly sessions of dialysis (AOR 9.05, CI 2.83-28.91, p=<0.001) were independently associated with a higher symptom burden. Out of every 10 patients, 3 did not report their symptoms to the physicians with cost concern as the most reason (70.4%, n=38). Conclusion: In this young population where access to dialysis is limited, the symptom burden is high (100%). Active screening and management of enabling factors may reduce symptom burden and cost concern is the frequent reason symptoms are not reported to physicians.