Physical Symptom Cluster Subgroups in Chronic Kidney Disease.
Mark B Lockwood, James P Lash, Heather Pauls and 6 others
PMID 31714343WHAT IT FOUND
Patients with mild-to-moderate kidney disease were classified into low, moderate, and high physical symptom groups.
High symptom burden was linked to lower kidney function, heart failure, atrial fibrillation, peripheral artery disease, and higher depression scores.
Key findings
013,921 participants with mild-to-moderate CKD were classified into low, moderate, and high physical symptom subgroups.
02For every 10 ml/min/1.73 m 2 increase in eGFR, risk of membership in the high versus low symptom subgroup decreased by 20%.
03Higher BDI scores and lower KDQOL-36 physical and mental component scores were associated with membership in the high versus low symptom subgroup.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis used baseline data only, so it cannot show whether symptom subgroups predict future outcomes or how symptoms change over time. The KDQOL-36 symptom profile includes only 11 physical symptoms and does not include affective symptoms, so it may not capture the full symptom burden. Model selection was not straightforward: the Bayesian information criterion suggested six clusters, entropy suggested three, and a likelihood ratio test suggested four, but the fourth cluster consisted of 18 participants missing symptom data. 130 participants were excluded from the regression because of missing covariate data, leaving 3,791 of the 3,921 analyzed. The stroke finding was based on a small number of participants with stroke history, n = 390. The study did not test any intervention, so it cannot tell whether risk stratification or symptom assessment improves care.
Declared interests
The authors reported no conflicts of interest. The article is listed as NIH extramural research support.
The easy way to misread this
Do not use these subgroups as a validated tool that predicts future kidney, cardiovascular, or quality-of-life decline. The analysis used baseline data only, so it shows associations at one time point and does not establish that symptom subgroups cause outcomes or that interventions based on them work.