Prevalence of Symptoms and Symptom Clusters of Patients on Dialysis in Uruguay

Abstract

Background: Patients on dialysis report high levels of symptom burden. The association of these symptoms may have an increased deleterious effect on the patients' well-being.

Objective: This study aimed to assess the prevalence of symptoms, to identify symptom clusters, and to describe the impact of concurrent symptoms on physical and emotional well-being in a sample of dialysis patients.

Methods: Data of the first assessment of a longitudinal study aimed to assess patient-reported outcomes in dialysis were included here. The KDQOL-36 PCS, MCS and Symptom Subscale, the Hospital Anxiety and Depression Scales and the Epworth Sleepiness Scale were analyzed. The ICLUST procedure was followed for hierarchical cluster analyses.

Results: Of the 512 eligible patients, 493 accepted to participate, 43.6 % were female, with mean age of 60.9 (SD=16.7). Treatment modality was HD in 87.6% of patients. Most prevalent and severe symptoms were muscle sores, cramps, "washed out", dry skin, and itchy skin, Moderate to severe pain was reported by 25%, and daily somnolence by 12.4% of the patients. Five first level symptom clusters were identified as cutaneous, cardiac, digestive, sensory-motor, energy. Both, the presence of any cluster and cluster scores were significantly associated with lower physical and mental quality of life and a higher psychological distress.

Conclusions: Our study confirms the presence of high symptom burden in dialysis patients in Uruguay. Several symptom clusters were identified having significant impact on the patients' well-being. The identification of symptom clusters can help to understand common underlying pathways. It is possible that the management of symptom clusters may reduce symptom burden in these patients.

Keywords: Uruguay; dialysis; hierarchical cluster analysis; symptom clusters.