Dialysis Symptom Index Research Articles

Correlation Between Symptom Clusters and Self-Management Among Maintenance Haemodialysis Patients: A Cross-Sectional Study.

The purpose of this study was to explore the relationship between symptom clusters and self-management among maintenance haemodialysis (MHD) patients. MHD patients experience disease progression and multiple symptom burdens that severely impact quality of life, and self-management of symptoms may significantly improve patient-reported outcomes. A cross-sectional study. This cross-sectional descriptive study included 194 patients undergoing MHD. The patients were assessed using the Dialysis Symptom Index (DSI) and the Haemodialysis Self-Management Instrument (HD-SMI). We used descriptive analysis, exploratory factor analysis, Pearson's correlation analysis and linear regression analysis to examine (1) the level of individual self-management, (2) the presence of symptom clusters by symptom severity and (3) the correlation between symptom clusters and self-management behaviours. This study was conducted in accordance with the STROBE checklist. The top five most severe symptoms among the patients were itching, feeling tired or lack of energy, difficulty sleeping, dry mouth and dry skin. We identified five groups of symptoms: (1) poor sleep, (2) neuromuscular, (3) gastrointestinal, (4) skin irritation and (5) psychological. In the present study, MHD patients reported low to moderate levels of self-management behaviours (50.84 ± 10.56), and low self-management ability was correlated with greater severity of the five symptom clusters (p < 0.01). Linear regression analysis revealed that all five symptom clusters were included in the regression equation, explaining 30% of the total variance in self-management skills among MHD patients. Enhanced awareness of symptom clusters and comprehensive symptom management are necessary to improve patients' quality of life. Nursing practices should incorporate comprehensive symptom assessments to help patients develop effective self-management strategies to improve quality of life.

Informal caregiver burden in dialysis care and how it relates to patients' health-related quality of life and symptoms.

Informal caregivers play a crucial role in dialysis care but may experience significant burden, potentially affecting both caregiver and patient outcomes. Research on caregiver burden and health-related quality of life (HRQoL) and the relation to patient-reported outcomes (PROs) is lacking. Therefore, we aimed to (i) describe informal caregivers' experienced burden and HRQoL and (ii) investigate how these are related to dialysis patients' HRQoL and symptoms. We conducted a cross-sectional study at dialysis initiation with 202 adult informal caregiver-dialysis patient dyads. Caregiver burden was measured with the Self-Perceived Pressure from Informal Care (SPPIC) questionnaire, HRQoL with the 12-item Short Form Health Survey (SF-12), and symptom number and burden with the Dialysis Symptom Index (DSI). Data were analysed using linear and logistic ordinal regression. Around 38% of caregivers experienced moderate to high burden. Patients' lower mental HRQoL [adjusted odds ratio (aOR)=0.95, 95% confidence interval (CI) 0.92; 0.99], higher symptom number (aOR=1.07, 95% CI 1.02; 1.12) and higher symptom burden (aOR=1.03, 95% CI 1.01; 1.04) were associated with greater odds of higher caregiver burden. Patients' lower mental HRQoL (β=0.30, 95% CI 0.15; 0.46), higher symptom number (β=-0.55, 95% CI -0.78; -0.31) and higher symptom burden (β=-0.17, 95% CI -0.25; -0.10) were also associated with a lower mental HRQoL in caregivers. We show that a third of caregivers feel moderate to high burden and that caregiver burden is associated with patients' mental HRQoL and symptoms. These findings highlight the importance of recognizing informal caregivers and the nature of their burden.

Symptom Burden in Patients on Maintenance Hemodialysis: Prevalence and Severity 17 Years Apart.

Objectives: The aim of this study is to compare data from two cohorts separated by a 17-year interval. We assessed the prevalence and severity of symptoms with the "dialysis symptom index" in these two groups, recruited in 2007 and 2024, to determine how advancements in dialysis therapy have influenced the symptom burden's prevalence and severity. Methods: End-stage renal diseases patients receiving maintenance hemodialysis three times a week in the hemodialysis unit of the university hospital were recruited between February and March 2007. In May 2024, in the same unit, another population sample was recruited and studied, as in 2007. The Dialysis Symptom Index (DSI) was administered to each patient, during the dialysis treatment. The DSI is made up of 30 questions, each of which addresses a specific physical or emotional symptom. The total symptom burden score, representing the total number of symptoms reported as being present, and the total symptom severity score, which represents the sum of individual severity scores, were generated for each patient. Results: We studied 71 patients in 2007 and 61 patients in 2024. The demographic, clinical and laboratory characteristics of the two study populations did not differ significantly. The total symptom burden score did not differ significantly between 2007 and 2024. The prevalence of most symptoms was similar in the two groups. The prevalence of constipation, decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. The total symptom severity was similar in the two periods. The severity of most symptoms was similar in the two groups. The severity of decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. Conclusions: The present study shows that, 17 years apart, the prevalence and severity of the symptom burden in patients on maintenance hemodialysis did not change significantly. These results suggest that studies investigating the causes and the pathogenesis of symptoms of patients on maintenance hemodialysis are urgently needed in the next future, as well as studies on therapeutic strategies.

Twice Weekly versus Thrice Weekly Hemodialysis-A Pilot Cross-Over Equivalence Trial.

The 2015 Update of the Kidney Disease Outcomes Quality Initiative (KDOQI) Guideline for Hemodialysis Adequacy increased the contribution of residual kidney function in calculating standard Kt/Vurea (stdKt/Vurea). However, no study has assessed the effect of prescribing twice weekly hemodialysis according to this guideline on patients' quality of life or uremic solute levels. Twenty six hemodialysis patients with average residual urea clearance (Kru) 4.7±1.8 ml/min and hemodialysis vintage of 12±15 months (range two months to 4.9 years) underwent a cross-over trial comparing four weeks of twice weekly hemodialysis and four weeks of thrice weekly hemodialysis. Twice weekly hemodialysis was prescribed to achieve stdKt/Vurea 2.2 incorporating Kru using the 2015 KDOQI Guideline. Thrice weekly hemodialysis was prescribed to achieve spKt/Vurea 1.3 regardless of Kru. Quality of life and plasma levels of secreted uremic solutes and β2 microglobulin (β2m) were assessed at the end of each period. Equivalence testing between twice and thrice weekly hemodialysis based on the Kidney Disease Quality of Life instrument (primary analysis) was inconclusive. Symptoms as assessed by the secondary outcomes Dialysis Symptom Index and post-dialysis recovery time were not worse with twice weekly hemodialysis. StdKt/Vurea was adequate during twice weekly HD (2.7±0.5), and ultrafiltration rate and plasma potassium were controlled with minimally longer treatment times (twice weekly: 195±20 vs. thrice weekly: 191±17 minutes). Plasma levels of the secreted solutes and β2m were not higher with twice weekly than thrice weekly hemodialysis. Twice weekly hemodialysis can be prescribed using the higher contribution assigned to Kru by the 2015 KDOQI Guideline. With twice weekly hemodialysis, quality of life was unchanged, and the continuous function of the residual kidneys controlled fluid gain and plasma levels of potassium and uremic solutes without substantially longer treatment times.

Exploring symptom clusters in Chinese patients with peritoneal dialysis: a network analysis

Background In recent years, the research on symptom management in peritoneal dialysis (PD) patients has shifted from a single symptom to symptom clusters and network analysis. This study collected and evaluated unpleasant symptoms in PD patients and explored groups of symptoms that may affect PD patients with a view to higher symptom management. Methods The symptoms of PD patients were measured using the modified Dialysis Symptom Index. The symptom network and node characteristics were assessed by network analysis, and symptom clusters were explored by factor analysis. Results In this study of 602 PD patients (mean age 47.8 ± 16.8 years, 47.34% male), most had less than 2 years of dialysis experience. Five symptom clusters were obtained from factor analysis, which were body symptom cluster, gastrointestinal symptom cluster, mood symptom cluster, sexual disorder symptom cluster, and skin-sleep symptom cluster. Itching and decreased interest in sex may be sentinel symptoms, and being tired or lack of energy and feeling anxious are core symptoms in PD patients. Conclusions This study emphasizes the importance of recognizing symptom clusters in PD patients for better symptom management. Five clusters were identified, with key symptoms including itching, decreased interest in sex, fatigue, and anxiety. Early intervention focused on these symptom clusters in PD patients holds promise for alleviating the burden of symptoms.

#2938 The association between serum iron biomarkers and health-related quality of life in patients undergoing dialysis

Abstract Background and Aims Anemia is a very common complication of chronic kidney disease, affecting most patients undergoing dialysis. Iron deficiency, one of the causes of anemia, is generally a second consideration in the management of anemia. Nephrologists mainly focus on the correction of hemoglobin, often prescribing iron therapy for this indication only. However, iron has important physiological functions besides erythropoiesis. Conversely, iron overload can lead to oxidative stress and cellular damage. Therefore, nephrologists have been cautious to prescribe iron therapy to patients with already high serum iron levels. This caution has been underscored by studies linking higher levels of iron to increased mortality. Unfortunately, evidence is lacking regarding the impact of iron on important patient-reported outcomes like health-related quality of life (HRQoL). Therefore, the aim of this study is to explore the association between serum iron biomarkers, health-related quality of life (HRQoL) and the presence of anemia-related symptoms over a one-year period in patients undergoing dialysis. Method Data were obtained from the multicenter, prospective, observational Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO). Adult patients new to dialysis were included, and had a baseline and follow-up assessments at 3, 6 and 12 months, with measurements of serum iron biomarkers ferritin and transferrin saturation (TSAT). HRQoL, encompassing physical and mental HRQoL, was measured using the validated 12-item Short Form Health Survey (SF12, summary scores ranging from 0 to 100). The presence of anemia-related symptoms: fatigue, shortness of breath, restless legs and muscle cramps were assessed using the Dialysis Symptom Index. Patients were categorized into 4 groups depending on their ferritin levels (μg/L): &amp;lt;200, 200–500 (reference), &amp;gt;500–700 and &amp;gt;700, and into 3 groups depending on their TSAT levels (%) at baseline: &amp;lt;20, 20–39 (reference), and ≥40. Longitudinal analyses were conducted using sequential conditional mean models to adjust for time-independent and time-varying confounding. All analyses captured the overall association over a one-year follow-up. Results We included 1069 patients, of whom 76% started hemodialysis, the median age was 68, 66% were male, and 32% were receiving iron therapy. Over a one-year follow-up, patients with ferritin &amp;lt;200 μg/L had similar physical HRQoL (MD=0.5 ; 95% CI –2.4 to 3.3 ) and mental HRQoL (MD=0.04 ; 95% CI -2.0 - 2.0) compared to the reference group with ferritin between 200–500 μg/L. Patients with ferritin between 501–700 μg/L also had a similar physical and mental HRQoL mental HRQoL compared to those with ferritin between 200-500 μg/L. This was also found for patients with ferritin above 700 μg/L (Fig. 1). Similarly, patients with TSAT levels below 20% and patients with TSAT levels ≥40% had comparable physical and mental HRQoL compared the reference group of patients with a TSAT between 20-39% (Fig. 2). For the secondary objectives, we found no significant differences in the anemia-related symptoms fatigue, shortness of breath, restless legs, or muscle cramps between patients with various levels of ferritin nor between the various TSAT groups. Conclusion We found that dialysis patients with higher or lower levels of ferritin or TSAT did not have a significantly different physical or mental HRQoL over a one year-follow up after starting dialysis. Similarly, no significant differences were found in the presence of fatigue, shortness of breath, restless legs, and muscle cramps between patients with these higher or lower levels of serum iron markers. And although iron levels do have impact on clinical outcomes such as mortality, these results suggest that they do not influence patient reported outcomes such as physical and mental HRQoL.

#2891 Comparing health-related quality of life and symptom burden in patients undergoing twice-weekly versus thrice-weekly haemodialysis

Abstract Background and Aims Patients with kidney failure who initiate haemodialysis (HD) have traditionally followed a thrice-weekly, 4-hour schedule. Recently, incremental dialysis (i.e. initiating HD with lower frequency and/or treatment duration) has been advocated. It has been suggested that residual kidney function is better preserved, while mortality is similar when initiating dialysis with a twice versus thrice weekly schedule. It remains unclear which impact initiating dialysis twice a week has on health-related quality of life (HRQoL) in the short and long term. Therefore, the aim of this study was first to investigate the impact of following a twice-weekly dialysis schedule on the mental and physical HRQoL and symptom burden compared to thrice-weekly dialysis during the first year of dialysis. Second, to investigate the long term impact on mental and physical HRQoL and symptom burden of patients who solely started on a twice-weekly versus thrice-weekly schedule. Method Data were obtained from the ongoing multicentre, prospective, observational Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO). This study longitudinally compares HRQoL between home and in-center dialysis. For this analysis, incident HD patients &amp;gt; 18 years were included, if they started on a twice-weekly or thrice-weekly schedule. Mental and physical HRQoL was measured using the validated 12-item Short Form Health Survey (SF12, summary scores ranging from 0 to 100). Symptom burden was measured using the dialysis symptom index (DSI), consisting of 30 items on dialysis-related symptoms, these symptoms are reported using a 5-point Likert scale. The overall burden score, ranging from 0 to 150, was calculated by summing every symptom and its severity. The first aim was longitudinally analysed using linear mixed models, using measures at 3, 6 and 12 months after start dialysis. The second aim was cross-sectionally analysed at 1, 2 and 3 years after dialysis initiation using linear regression models. All models were adjusted for possible confounders. Results A total of 1007 patients were included, of whom 205 started on a twice-weekly schedule and 802 on a thrice-weekly schedule. The total population had a mean age of 64 ± 15 years and 35% were women. There was no significant difference in baseline characteristics between twice-weekly and thrice-weekly dialysis. At baseline mental and physical HRQoL for patients on twice-weekly dialysis were 45.9 ± 9.5 and 36.0 ± 10.7, respectively. In thrice-weekly dialysis this was 45.8 ± 10.3 and 35.0 ± 9.7. The symptom burden score at baseline was 33.0 ± 19.6 for twice-weekly and 34.0 ± 21.7 for thrice-weekly patients. As shown in Table 1, there were no significant differences in HRQoL or symptom burden over the first year of dialysis when comparing twice-weekly with thrice weekly HD. In Table 2 the long-term cross-sectional analyses show that starting with a twice-weekly schedule results in physical and mental HRQoL scores gradually becoming lower, with a statistically significant decrease in physical HRQoL score at 3 years after start dialysis (ß = −0.825, 95% CI −14.11; −2.38). There was no significant difference in symptom burden between the two schedules. Conclusion We found no differences in HRQoL or symptom burden during the first year of dialysis comparing incident patients on a twice-weekly versus thrice-weekly hemodialysis schedule. Conversely, starting on a twice-weekly dialysis schedule appears to be associated with a lower HRQoL, especially physical HRQoL, in the longer term. Following our results, physicians should be cautious of the possible negative effects on HRQoL when prescribing a twice-weekly dialysis schedule.

#672 Intradialytic hypotension and adverse symptoms are not related

Abstract Background and Aims Intradialytic hypotension (IDH) is the most common side-effect of intermittent hemodialysis (HD). Yet, its definition lacks consensus about the magnitude of blood pressure (BP) drops, occurrence of adverse symptoms (AS) and/or interventions. Generally, BP is measured twice/hour, while additional readings are carried out when AS arise. Consequently, AS became a prerequisite for the diagnosis of IDH, both in the National Kidney Disease Outcomes Quality Initiative (KDOQI) and in the European Best Practice Guideline (EBPG). Yet, a large study on the associations between 8 IDH definitions and mortality, showed that an absolute nadir systolic blood pressure (SBP) &amp;lt;90 mmHg or &amp;lt;100 mmHg (with a pre-dialysis SBP &amp;lt; 160 mmHg or SBP ≥160 mmHg resp.) is most strongly associated with mortality. Neither AS nor interventions were related to outcome. Due to the absence of reliable studies, however, it is still unclear whether IDH and AS are related. Therefore, 1) the occurrence of (a)symptomatic IDH was evaluated according to the nadir-based definition; 2) relations between real-time AS and IDH were explored; 3) associations between IDH-susceptibility and physical intradialytic patient-reported outcome measures (PID-PROMS) were analysed. Methods Forty HD patients were cross-over randomized to standard HD (S-HD), cool HD (C-HD), low-(LV) and high-volume (HV) hemodiafiltration (HDF), each for two weeks. Every second week, BP was measured every 15 minutes during treatment. While AS were monitored real-time, PID-PROMS were documented after each modality with a modified dialysis symptom index [mDSI] questionnaire. The occurrence of symptomatic and asymptomatic IDH, defined as a SBP &amp;lt; 90 or 100 mmHg (depending on the pre-dialysis SBP), was evaluated. For each presentation of AS, we assessed its association with blood pressure by examining concurrent IDH using both the KDOQI/EBPG definitions and the nadir-based definition (Fig. 2). Patients were stratified into tertiles of IDH (IDH-prone, IDH-intermediate and IDH-resistant). The frequency and severity of discrete symptoms, recovery time and total symptom-burden were compared using logistic regression models and Kruskal-Willis tests. Results In 458 sessions, 222 IDH-episodes occurred of which 98% were asymptomatic. While nursing records revealed 24 real-time AS, 54% was BP-related and 17% fulfilled the nadir-based criteria, leaving 46% of AS unrelated to IDH (Fig. 2). IDH-prone patients experienced headaches more frequently (p = 0.01), and perceived dizziness (p = 0.05) and shivering (p &amp;lt; 0.01) more severely. No associations were found between IDH-susceptibility and symptom-burden, recovery time, or other discrete side-effects. Conclusions 1) Most IDH-episodes are asymptomatic; 2) Conversely, 46% of AS occur without IDH and (3) PID-PROMS are completely independent of IDH-susceptibility. 4) Symptom-based definitions severely underestimate IDH, when compared to a nadir-based IDH definition.

Relationship Between Fluid Control and Symptom Severity in Hemodialysis Patients

Objective: This study was conducted to determine fluid control and symptom severity in hemodialysis patients, to reveal related factors, and to determine the relationship between fluid control and symptom severity. Methods: The descriptive and correlational study was conducted with 150 patients receiving treatment in a private hemodialysis center in Istanbul between 01-30 April 2022. Data were obtained using a patient identification form, the Fluid Control Scale in Hemodialysis Patients and the Dialysis Symptom Index. Results: The mean Fluid Control Scale in Hemodialysis Patients score of the patients was 50.75±8.13. The mean Dialysis Symptom Index score of the patients was 19.09±17.08. In addition, it was found that there was a weak negative correlation between the mean scores of the Fluid Control Scale in Hemodialysis Patients and the Dialysis Symptom Index (r=-0.349; p&amp;lt;0.05). Conclusion: It has been determined that the fluid control of hemodialysis patients is generally at a moderate level, the symptom severity is quite low, and the symptom level may decrease as the level of knowledge, behavior, and attitude toward fluid control increases. It is recommended that nurses should regularly educate and counsel hemodialysis patients about the importance of fluid control and closely monitor the patient's compliance with fluid control.

Exploring Symptom Clusters in Chinese Patients with Diabetic Kidney Disease: A Network Analysis.

The research on symptom management in patients with diabetic kidney disease (DKD) has shifted from separate symptoms to symptom clusters and networks recently. This study aimed to evaluate the unpleasant symptoms of DKD patients, and to investigate how these symptom clusters could affect patients. 408 DKD patients were recruited in this cross-sectional study. The symptoms of DKD patients were measured using the modified Dialysis Symptom Index. Network analysis was employed to evaluate the symptom network and the characteristics of individual nodes, while factor analysis was utilized to identify symptom clusters. Blurred vision was the most prevalent symptom among DKD patients. The symptoms identified as the most distressing, severe, and frequent were light headache or dizziness, arteriovenous fistula/catheterization pain, and diarrhea, respectively. Five symptom clusters were obtained from factor analysis, and the most central symptom cluster in the entire symptom network was sexual dysfunction. This study identified five symptom clusters in Chinese DKD patients, with sexual dysfunction emerging as the most central cluster. These findings carry significant clinical implications, underscoring the necessity of assessing symptom clusters and their associations to enhance symptom management in DKD patients. Further research is essential to elucidate the underlying mechanisms of symptoms and to clarify the associations among symptoms in DKD patients across different disease trajectories or treatment modalities.

Cross-cultural validation of the Portuguese version of the Dialysis Symptom Index for haemodialysis patients.

Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) are associated with low quality of life (QoL) and high disease-related symptoms. The patient self-report instruments can assess the burden of physical and psychological symptoms. The Dialysis Symptom Index (DSI) is a specific instrument to evaluate the multidimensional reported symptoms by patients undergoing HD. To translate, validate and assess the psychometric properties of the Portuguese version of the DSI. A cross-cultural adaptation process from English to Portuguese and a validation study (n = 156) were conducted. Reliability, validity and responsiveness were assessed. The patients' most reported symptoms were, nausea (n = 86, 55%), muscle cramps (n = 92, 59%), feeling tired or lack of energy (n = 92, 59%), bone or joint pain (n = 88, 56%) and trouble staying asleep (n = 95, 60%). Cronbach's alpha of the DSI was 0.87, and intraclass correlation coefficient was 0.868 (95%CI 0.836-0.896). The smallest detectable change was 28.32. The Portuguese DSI demonstrates excellent psychometric properties for assessing HD patients' reported symptoms. It highlights symptom severity and impact, providing valuable insights for healthcare practitioners. Nurses can use the DSI to tailor interventions and enhance patient-centred care.

Commentary: Cross-cultural validation of the Portuguese version of the Dialysis Symptom Index for haemodialysis patients.

Commentary: Cross-cultural validation of the Portuguese version of the Dialysis Symptom Index for haemodialysis patients.

Association of Dialysis Adequacy, Physical and Emotional Symptoms with Erythropoietin-stimulating agent Responsiveness in Iraqi Patients Undergoing Hemodialysis

Background: Erythropoietin (EPO)-deficient anemia occurs in patients with chronic kidney disease (CKD). Erythropoietin-stimulating agents (ESAs) are the standard treatment for CKD anemia, but patient responses vary. Hemodialysis patients are often anemic due to hypo erythropoiesis and their chronic inflammatory state. Inadequate dialysis is considered one of the factors that are linked to ESA hypo responsiveness. Dialysis patients may experience many symptoms that lower their quality of life. End stage renal disease (ESRD) symptoms are assessed using Dialysis Symptom Index (DSI). Objective: The current study was designed to measure the association between physical, and emotional symptoms and ESA responsiveness. Also, to determine how dialysis adequacy affects response level.Materials and Methods: The current study included 150 CKD anemic patients in a multicenter dialysis units. patients were examined for the response to Epoetin alfa (Eprex) after 12 weeks in this cross-sectional study. Clinical, demographic, and laboratory data were collected. The erythropoietin resistance index (ERI) evaluated the effect of erythropoietin dosage on hemoglobin levels. Dialysis adequacy (Kt/V) measured the efficacy of dialysis. The severity of symptoms was evaluated using the 30-question Dialysis Symptom Index (DSI). Results: 150 patients in all were enrolled, with a mean age of 51.6 ± 14.9 for the male patients. There was a significant difference in kt/v among study groups, mainly between hypo response and resistance groups (P-value &lt; 0.01). However, there was no statistically significant difference in the DSI mean (P = 0.4). kt/v was positively correlated with the duration of dialysis and parathyroid hormone (PTH) (R = 0.27, P-value &lt; 0.001), (R = 0.19, P-value = 0.01). additionally, The DSI was strongly connected with the age of the patients (R = 0.18, P-value = 0.02). Conclusion: One of the main causes of Eprex resistance in this study was insufficient dialysis. Patients who received longer hemodialysis sessions exhibited higher hemodialysis sufficiency. However, there was no significant association between DSI and degree of response across research groups, and older hemodialysis patients experienced higher dialysis-related symptoms.

Randomized Controlled Trial of the Effect of an Exercise Rehabilitation Program on Symptom Burden in Maintenance Hemodialysis: A Clinical Research Protocol.

People receiving hemodialysis experience high symptom burden that contributes to low functional status and poor health-related quality of life. Management of symptoms is a priority for individuals receiving hemodialysis but limited effective treatments exist. There is emerging evidence that exercise programming can improve several common dialysis-related symptoms. The primary aim of this study is to evaluate the effect of an exercise rehabilitation program on symptom burden in individuals receiving maintenance hemodialysis. Multicenter, randomized controlled, 1:1 parallel, open label, prospective blinded end point trial. Three facility-based hemodialysis units in Winnipeg, Manitoba, Canada. Adults aged 18 years or older with end-stage kidney disease receiving facility-based maintenance hemodialysis for more than 3 months, with at least 1 dialysis-related symptom as indicated by the Dialysis Symptom Index (DSI) severity score >0 (n = 150). Supervised 26-week exercise rehabilitation program and 60 minutes of cycling during hemodialysis thrice weekly. Exercise intensity and duration were supervised and individualized by the kinesiologist as per participant baseline physical function with gradual progression over the course of the intervention. Usual hemodialysis care (no exercise program). Our primary outcome is change in symptom burden at 12 weeks as measured by the DSI severity score. Secondary outcomes include change in modified DSI severity score (includes 10 symptoms most plausible to improve with exercise), change in DSI severity score at 26 and 52 weeks; time to recover post-hemodialysis; health-related quality of life measured using EuroQol (EQ)-5D-5L; physical activity behavior measured by self-report (Godin-Shepherd questionnaire) and triaxial accelerometry; exercise capacity (shuttle walk test); frailty (Fried); self-efficacy for exercise; and 1-year hospitalization and mortality. Change in primary outcome will be compared between groups by independent 2-tailed t test or Mann-Whitney U test depending on data distribution and using generalized linear mixed models, with study time point as a random effect and adjusted for baseline DSI score. Similarly, change in secondary outcomes will be compared between groups over time using appropriate parametric and nonparametric statistical tests depending on data type and distribution. The COVID-19 pandemic restrictions on clinical research at our institution delayed completion of target recruitment and prevented collection of accelerometry and physical function outcome data for 15 months until restrictions were lifted. The application of an exercise rehabilitation program to improve symptom burden in individuals on hemodialysis may ameliorate common symptoms observed in individuals on hemodialysis and result in improved quality of life and reduced disability and morbidity over the long term. Importantly, this pragmatic study, with a standardized exercise intervention that is adaptable to baseline physical function, addresses an important gap in both clinical care of hemodialysis patients and our current knowledge.

Assessment of symptom frequency and severity in hemodialysis patients using the dialysis symptom index (DSI); A single center experience

Assessment of symptom frequency and severity in hemodialysis patients using the dialysis symptom index (DSI); A single center experience

Non-adherence, medication beliefs and symptom burden among patients receiving hemodialysis -a cross-sectional study

BackgroundNon-adherence to medication is a common and complex issue faced by individuals undergoing hemodialysis (HD). However, more knowledge is needed about modifiable factors influence on non-adherence. This study investigated the prevalence of non-adherence, medication beliefs and symptom burden and severity among patients receiving HD in Denmark. Associations between non-adherence, medications beliefs and symptom burden and severity were also explored.MethodA cross-sectional questionnaire-based multisite study, including 385 participants. We involved patient research consultants in the study design process and the following instruments were included: Medication Adherence Report Scale, Beliefs about Medication Questionnaire and Dialysis Symptom Index. Logistic regression analysis was performed.ResultsThe prevalence of non-adherence was 32% (95% CI 27–37%) using a 23-point-cut-off. Just over one third reported being concerned about medication One third also believed physicians to overprescribe medication, which was associated with 18% increased odds of non-adherence. Symptom burden and severity were high, with the most common symptoms being tiredness/ lack of energy, itching, dry mouth, trouble sleeping and difficulties concentrating. A high symptom burden and/or symptom severity score was associated with an increased odd of non-adherence.ConclusionThe study found significant associations between non-adherence and, beliefs about overuse, symptom burden and symptom severity. Our results suggest health care professionals (HCP) should prioritize discussion about medication adherence with patients with focus on addressing patient-HCP relationship, and patients’ symptom experience. Future research is recommended to explore the effects of systematically using validated adherence measures in clinical practice on medication adherence, patient-HCP communication and trust. Additionally, studies are warranted to further investigate the relationship between symptom experience and adherence in this population.Trial registrationNCT03897231.

Examination of Dysfunctional Beliefs and Attitudes About Symptoms, Sleep Quality and Sleep in Patients Receiving Hemodialysis Treatment

Objective: This study was conducted to examine the relationship between symptoms, sleep quality, and dysfunctional beliefs and attitudes about sleep in patients receiving hemodialysis treatment.&#x0D; Material and Methods: This descriptive and correlational study was conducted with 120 patients undergoing hemodialysis in a private hemodialysis center. Data were collected using the Descriptive Information Form, Dialysis Symptom Index (DSI), Pittsburgh Sleep Quality Index (PSQI), and Dysfunctional Beliefs and Attitudes About Sleep Scale-16 (DBAS-16). The statistical analysis of the data obtained as a result of the study was analyzed using number, percentage, standard deviation and arithmetic mean as descriptive statistics, Pearson correlation test and structural equation modeling in IBM SPSS 26 program. Ethics committee approval and permission from the research institution were obtained for the conduct of the study. &#x0D; Results: The most common hemodialysis-related symptoms were fatigue (70.8%), feeling irritable (61.7%), difficulty falling asleep (60.8%). The mean PSQI Global sleep score of the patients was 7.40±5.02 points. Dialysis Symptom Index explained 26.5% of the change in PSQI Global sleep score in a statistically significant way (F=42.479 p

Health-related quality of life and symptom burden in patients on haemodialysis.

Patients on haemodialysis (HD) generally experience poor health-related quality of life (HRQoL) and a broad range of physical and mental symptoms, but it is unknown whether this differs between younger and older patients. We aimed to describe the trajectories of HRQoL and symptom burden of patients <70 and ≥70years old and to assess the impact of symptom burden on HRQoL. In incident Dutch HD patients, HRQoL and symptoms were measured with the 12-item Short Form Health Survey and Dialysis Symptom Index. We used linear mixed models for examining the trajectories of HRQoL and symptom burden during the first year of dialysis and linear regression for the impact of symptom burden on HRQoL. In 774 patients, the trajectories of physical HRQoL, mental HRQoL and symptom burden were stable during the first year of dialysis. Compared with patients <70years of age, patients ≥70years reported similar physical HRQoL {mean difference -0.61 [95% confidence interval (CI) -1.86-0.63]}, better mental HRQoL [1.77 (95% CI 0.54-3.01)] and lower symptom burden [-2.38 (95% CI -5.08-0.32)]. With increasing symptom burden, physical HRQoL declined more in older than in younger patients (β=-0.287 versus -0.189, respectively; P-value for interaction=.007). For mental HRQoL, this decrease was similar in both age groups (β=-0.295 versus -0.288, P=.847). Older HD patients generally experience a better mental HRQoL and a (non-statistically significant) lower symptom burden compared with younger patients. Their physical HRQoL declines more rapidly with increasing symptom burden.

Exploring the influencing factors of unmet palliative care needs in Chinese patients with end-stage renal disease undergoing maintenance hemodialysis: a cross-sectional study

BackgroundThe role of palliative care for end-stage renal disease (ESRD) patients have been proven in some developed countries, but it is still unclear in the mainland of China. In fact, patients with ESRD experience many unmet palliative care needs, such as physical, psychological, social and spiritual needs, but the factors influencing these needs have not investigated.MethodsA cross-sectional study was conducted at two hemodialysis centers in the mainland of China from January to September 2022. Convenience sampling was used to collect data on the participants' socio-demographics, clinical characteristics, the Palliative Care Outcome Scale (POS), the Dialysis Symptom Index (DSI), the Karnofsky Performance Status Scale (KPS), the Patient Health Questionnaire-9 item (PHQ-9), and the Social Support Rate Scale (SSRS). Data were analyzed using latent profile analysis, Kruskal–Wallis test, one-way analysis of variance (ANOVA), the chi-square test and multinomial logistic regression analysis.ResultsThree hundred five participants were included in this study, and divided palliative care needs into three categories: Class 1, mild palliative care needs (n = 154, 50.5%); Class 2, moderate palliative care needs (n = 89, 29.2%); Class 3, severe palliative care needs (n = 62, 20.3%). Based on the analysis of three profiles, the influencing factors of unmet needs were further analyzed. Compared with Class 3, senior high school education, the household per capita monthly income < 2,000, low KPS scores, high PHQ-9 scores, and low SSRS scores were less likely to be in Class 1 (OR = 0.03, P = 0.012; OR = 0.003, P < 0.001; OR = 1.15, P < 0.001; OR = 0.55, P < 0.001; OR = 1.35, P = 0.002; respectively) and Class 2 (OR = 0.03, P = 0.007; OR = 0.05, P = 0.011; OR = 1.10, P = 0.001; OR = 0.60, P = 0.001; OR = 1.32, P = 0.003; respectively), and high symptom severity were less likely to be in Class 1 (OR = 0.82, P = 0.001). Moreover, compared with Class 1, the household per capita monthly income < 2,000 (OR = 16.41, P < 0.001), high symptom severity scores (OR = 1.12, P = 0.002) and low KPS scores (OR = 0.95, P = 0.002) were more likely to be in Class 2.ConclusionsThis study showed that almost half of ESRD patients receiving MHD presented moderate to severe palliative care needs, and the unmet needs were mainly affected by education level, financial pressure, functional status, symptom burden and social support. In the future, it is important to identify the populations with the greatest need for palliative care and consider the influencing factors of unmet needs from a comprehensive perspective, so as to help them improve health-related quality of life.

#2814 WHAT ABOUT THE IMPACT ON INFORMAL CAREGIVERS? EFFECTS OF DIALYSIS PATIENTS' HEALTH-RELATED QUALITY OF LIFE AND SYMPTOM BURDEN ON CAREGIVERS

Abstract Background and Aims Starting dialysis has a major impact on patients’ lives. Dialysis patients experience impairments in health-related quality of life (HRQoL) and high symptom burden. Informal caregivers are crucial for dialysis patients’ well-being, as patients often rely on their support and care. However, informal caregivers who provide long-lasting, intensive care may also experience a significant burden. This, in turn, may lead to impaired HRQoL of both the informal caregiver and the patient. To date, little research has been done among informal caregivers of dialysis patients, even though they may experience negative effects of the impaired functioning of the patient. Therefore, the aim of this study was to assess the impact of dialysis patients’ HRQoL and symptom burden on HRQoL of their informal caregivers. We hypothesize that impaired HRQoL and high symptom burden of dialysis patients have a significant impact on informal caregivers’ mental HRQoL, but little to no impact on their physical HRQoL. Method We conducted a cross-sectional study with 193 dyads of adult dialysis patients and their informal caregivers. Data at dialysis initiation were obtained from the ongoing multicenter, observational cohort study on informal caregivers of dialysis patients, which is an extension of the Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes (DOMESTICO). The 12-item Short Form Health Survey (SF-12), which provides mental component summary (MCS) and physical component summary (PCS) scores (range 0-100), was used to measure HRQoL in both informal caregivers and dialysis patients. The number of symptoms (range 0-30) and symptom burden (range 0-150) were measured with the Dialysis Symptom Index (DSI). Data were analyzed using linear regression and adjusted for possible confounders. Results Mean age of informal caregivers was 60 ± 15 years, 72.0% were female, and 77.2% were spouses of the dialysis patient. Mean age of patients was 65 ± 14 years, 32.1% were female, and 62.7% were on in-centre hemodialysis. Mean MCS and PCS scores of informal caregivers were 47.8 ± 9.7 and 48.7 ± 9.8, respectively. Mean MCS and PCS scores of patients were 47.9 ± 9.0 and 35.7 ± 10.3, respectively, and mean symptom number and burden were 11.3 ± 5.9 and 31.5 ± 17.6, respectively. After adjustment for confounders, significant effects of patients’ (1) MCS score (β = 0.305; p = 0.003), (2) symptom number (β = -0.434; p = 0.002), and (3) symptom burden (β = -0.151; p &amp;lt; 0.001) were found on caregivers’ MCS score. No significant effects on caregivers’ PCS score were found. Conclusion Lower mental HRQoL, higher symptom number, and higher symptom burden of dialysis patients are associated with lower mental HRQoL of their informal caregivers. These findings underline the importance of maintaining patients’ HRQoL and reducing symptom burden, as these also affect informal caregivers. In addition, given that improving patients’ HRQoL and reducing symptom burden are not always within reach, these findings emphasize the importance of supporting informal caregivers of dialysis patients.