Fatigue, reduced sex drive, sexual arousal named most burdensome symptoms after dialysis
Click Here to Manage Email Alerts
Fatigue, decreased interest in sex and difficulty becoming sexually aroused were the most burdensome symptoms among older adults after dialysis initiation, according to data in the Clinical Journal of the American Society of Nephrology.
“The high burden of fatigue in older patients starting dialysis is often multifactorial, among others including older age, low residual kidney function, uremic toxins, heart failure, anemia, high ultrafiltration volume, anxiety, depression and poor sleep quality,” Esther N.M. de Rooij, MD, a PhD student at Leiden University Medical Center, and colleagues wrote.
In the ongoing, multicenter, prospective European Quality study, de Rooij and colleagues explored symptoms exhibited during the year preceding and the year following dialysis initiation in 456 patients who were at least 65 years old and had an incident eGFR less than or equal to 20 mL/min per 1.73 m².
Patients who started hemodialysis or peritoneal dialysis and experienced at least one symptom during the year before or after initiation were included in the study. Patients were followed every 3 to 6 months between 2012 and 2021 until kidney transplantation, refusal for further participation, transfer to a nonparticipating center, loss to follow-up, end of follow-up or death, whichever came first.
The presence of 30 symptoms were reported via questionnaire by patients in the past month. For each symptom present, patients rated symptom burden on a five-point Likert scale, ranging from one for “not at all” to five for “very much” burdensome. Non-experienced symptoms were scored at zero, resulting in a total symptom burden score that ranged from zero to 150, with higher scores indicating greater burden.
Investigators found the prevalence and burden of cardiopulmonary symptoms, fatigue, emotional symptoms and sleep disorders mainly increased during the year before and stabilized or decreased after dialysis initiation.
Symptom number increased 3.6 (95% CI, 2.5-4.6) and symptom burden increased 13.3 (95% CI, 9.5-17) in the year before dialysis. The following year, symptom number decreased 0.9 (95% CI, –3.4 to 1.5) and burden decreased 5.9 (95% CI, –14.9 to –3).
Symptoms with the highest prevalence included “fatigue” at 81%, with a burden of 2.7; “decreased interest in sex” at 69%, with a burden of 2.4; and “difficulty becoming sexually aroused” at 68%, with a burden of 2.3.
“Our results emphasize the importance of identifying and discussing kidney failure-related symptoms in routine clinical care and considering their differing patterns of evolution
before and after dialysis initiation,” de Rooij and colleagues wrote. “Indeed, increased physician awareness may lead to better symptom control and improve total symptom burden.”
In an accompanying press release, de Rooij said, “We hope these results could help inform older patients with kidney failure who decide to start dialysis on what to expect regarding the development of their symptom burden.”
Reference:
Study examines symptom burden before and after starting dialysis in older adults. https://www.newswise.com/articles/study-examines-symptom-burden-before-and-after-starting-dialysis-in-older-adults?sc=dwhr&xy=10007438/?ad2f=1&aid=781862. Published Nov. 10, 2022. Accessed Nov. 30, 2022.
Collapse
Read more about
Click Here to Manage Email Alerts