KDIGO releases new report on managing symptom burden of dialysis
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Key takeaways:
- KDIGO has released new guidelines on managing the symptom burden of dialysis care.
- Common symptoms include itching, fatigue, pain, dry skin, poor sleep, muscle cramps and depression.
The Kidney Disease: Improving Global Outcomes has released a new report for the kidney community on managing the symptom burden of dialysis.
“The frequency and burden of symptoms experienced by people on hemodialysis and peritoneal dialysis is increasingly recognized throughout the medical community,” Edwina A. Brown, MD, of the Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, and co-chair of the Kidney Disease: Improving Global Outcomes (KDIGO) Symptom-Based Complications in Dialysis Controversies Conference, said in a press release. “These wide-ranging symptoms include itching, fatigue, pain, dry skin, poor sleep, muscle cramps and depression.”
Rajnish Mehrotra, MD, MS, professor of medicine and interim head of the division of nephrology at Harborview Medical Center in Seattle and lead author of the report, wrote with other conference participants that the impact of dialysis therapy on patient mental and social well-being is often overlooked.
“Individuals with kidney failure undergoing maintenance dialysis frequently report a high symptom burden that can interfere with functioning and diminish life satisfaction. Until recently, the focus of nephrology care for dialysis patients has been related primarily to numerical targets for laboratory measures, and outcomes such as cardiovascular disease and mortality,” they wrote. “Routine symptom assessment is not universal or standardized in dialysis care. Even when symptoms are identified, treatment options are limited and are initiated infrequently, in part because of a paucity of evidence in the dialysis population and the complexities of medication interactions in kidney failure.”
Identifying and assessing those symptoms should be part of routine clinical practice and can be achieved through several approaches, including by asking open-ended questions or using patient-reported outcome measures (PROMs), Mehrotra said in the release. “PROMs have been used widely in clinical effectiveness research,” Mehrotra said. “Some PROMs, such as screening for depression or assessment of health-related quality of life, are used routinely in some parts of the world, and they may enhance the patient–provider relationship, improve communication and support shared decision-making. However, to optimize the use of PROMs in clinical settings, gaps between practice and evidence must be closed, and the value of their use, given the resources required from both clinicians and patients, must be determined.”
Added Brown, “Many of these symptoms can be improved with proper assessment and individualized management. We believe that nephrology teams can and should play a major role in helping patients manage symptoms without needing to manage all aspects of care.”
Mehrotra, who is also co-chair of the conference, said more research is needed to develop treatments and approaches to improving care for patients on dialysis.
“Research should engage patients, care partners, families, dialysis clinic personnel, nephrology care team members, trainees, dialysis providers, pharmaceutical companies and payers at all stages,” he said. “It is certainly possible to reduce symptoms for people on dialysis, and symptom management should be a top research priority in kidney failure."
The full KDIGO Controversies Conference report can be downloaded at https://kdigo.org/conferences/symptom-based-complications-in-dialysis/.
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