Study Of Symptoms In Hemodialysis Patients

Background:Hemodialysis(HD) is the main renal replacement therapy(RRT) for end-stage renal disease(ESRD) patient. However, patients on HD experienced multiple symptoms, which strongly influenced their quality of life. Therefore, a comprehensive symptom assessment and targeted management is very necessary in HD patients.Objective:(1) Based on the Theory of Unpleasant Symptoms (TOUS), to describe symptoms experienced by HD patients from four aspects:prevalence, frequency, severity and distress. (2) Based on the Dialysis Symptom Index, to explore relationship between symptoms and develop symptom clusters. (3) To explore factors that influence patients’ symptom experience.Methods:This was a descriptive, cross-sectional study. A convenience sample of 186 HD patients was recruited from three dialysis centers in Beijing. Patients were asked to complete the adapted Dialysis Symptom Scale.Results:(1) An average of 10 symptoms were experienced by HD patients, with feeling tired or lack of energy(68.8%), itching(66.1%), dry skin(64.5%) the most prevalent. While the most frequently reported symptom during the last week was dry skin(38.2%), fatigue was the most severe(46.2%) and bothersome(20.4%) one among all 30 symptoms. (2) Spearman correlation showed significant relationships between symptoms. Using principal component analysis, five symptom clusters were identified and named as psychological cluster, water and electrolytes cluster, general uremic cluster, gastrointestinal cluster and sexual dysfunction cluster. All symptoms explained 60.063% of the total variance. (3) Multiple linear regression analysis for the square root of total symptom score on three dimensions indicated that 1) coronary heart disease, hyperkalemia, hypertension and diabetes were the influencing factors which could explain 13.1%variance of the square root for total frequency and 15.8% variance of the square root for total severity,2) coronary heart disease, hyperkalemia, and hypertension were the influencing factors which could explain 12.2% variance of the square root for total bother.Conclusion:Patients on HD experience multiple symptoms concurrently that can be catalyzed with each other. Due to some demographic and disease characteristics, symptoms experienced by different HD patients could be very different. Interventions should be developed to reduce symptom burden.