Symptom Clusters in Hemodialysis

The cycle of waste and electrolyte dysregulation, disease-related volume expansion, and fluid removal by HD leads to hypertension and heart failure, with accompanying symptoms of shortness of breath, cognitive impairment, nausea, anorexia, fatigue, weakness and edema. Fluid removal (ultrafiltration) during HD further exacerbates the symptom burden.^1-5 HD patients, therefore, can suffer from a variety of physical and emotional symptoms. A relatively small number of studies have aimed to quantify and/or qualify symptom burden and symptom clusters in HD patients.^6-11 The majority of the available literature has not examined the wide range of symptoms that are known to affect this population and has used general quality of life measures or ad hoc instruments.^{12, 13} Improved recognition and identification of symptoms experienced independently and concurrently could translate into the development of symptom prevention and management interventions. The purpose of this presentation is to explore the symptom burden experienced by patients in the hemodialysis (HD) patient population and identify HD patient symptom clusters.

Methods

We conducted a secondary analysis on a 42 patient HD patient sample of a double-blinded randomized controlled trial. Patients were randomized to one of three dietary sodium intake groups (1500 mg/day, 2400 mg/day, ambient intake group). Primary outcomes were quality of life and symptom scores as operationalized by the Kidney Quality of Life (KDQOL) and Palliative Outcome Scale-Renal (POS-S) Assessments. POS-S scores were utilized for the symptom cluster analyses.

Principal components analysis with a varimax rotation was used to identify symptom clusters in the convenience hemodialysis patient sample.

Results

The sample was overwhelmingly African American (85 %) and predominately male. The mean age was 56 years (SD=11.69). The Forty-five percent reported hypertension as the etiology of ESRD. The majority of participants perceived their health to be at least “good” (55%). Baseline quality of life scores were the same across the sample. No statistically significant difference in symptom scores. Four symptom clusters emerged from the cluster analyses.

There were limitations to our study. In particular, the primary Study was a feasibility study with minimal power, a small convenience sample and the survey consisted of 17 items. We also found that some of the survey items correlated heavily with one another. Sampling bias may also have been a factor in the results of the study.

Conclusions

A larger scale RCT is necessary to explore clinical relevance of symptom clusters identified.

Symptom Cluster research is its infancy in the HD patient population. Further analyses with larger samples are necessary to begin to develop interventions to improve the patient symptom experience.