Symptom burden amongst patients suffering from end-stage renal disease and receiving dialysis: A literature review.
Hong Li, Lantian Xie, Jie Yang and 1 others
PMID 31406859WHAT IT FOUND
Dialysis patients often report many distressing symptoms, including dry skin, fatigue, itching, pain and sleep problems.
Nurses can use brief symptom scales and ask about frequency, severity and distress, not only the main complaint.
Key findings
01In 162 patients receiving maintenance haemodialysis, the median number of symptoms was 9.0 (interquartile range 6 to 13), and dry skin, fatigue, itching and bone/joint pain were reported by at least 50% of patients.
02Five scales are commonly used to assess symptom burden in dialysis patients, but four do not cover multiple symptom attributes; the Dialysis Symptom Index is common but may create response burden because of many items.
03The review reports that dialysis symptom burden is comparable with advanced cancer, and that tiredness was the most commonly reported, most frequent, most bothersome and most severe symptom in a study of 99 haemodialysis patients.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The paper presents a review of related research and does not state a systematic search or appraisal method. The cited studies are mostly cross-sectional, and the review notes few longitudinal, qualitative and interventional studies. Most cited research focuses on haemodialysis or dialysis broadly, and the review says symptom burden in peritoneal dialysis is poorly understood. The evidence on factors is inconsistent: some studies link age, gender, income, education, dialysis duration and laboratory values with burden, while other studies did not find these associations. Assessment tools have limitations: DSI and MSAS-SF may create response burden, MSAS-SF omits common dialysis symptoms, KDQOL-SF has a long recall period, and POSs-renal reliability and validity are not established. Scales are mostly from other countries, and the review says tools suited to China's cultural background are needed.
Declared interests
No conflicts of interest or funding were declared.
The easy way to misread this
Do not read this review as proof that treating these symptoms improves dialysis outcomes. It reports what patients experience and how burden is measured, not the effect of an intervention.