People with CKD experience a high symptom burden, although little is known about the burden for people with CKD Stage 4 and for those with CKD Stage 5 receiving peritoneal dialysis. This review recommends that a full range of symptoms be assessed for those at different stages of CKD. Improved understanding of the burden of symptoms can be used as the basis for treatment choices and for identifying priorities which are likely to contribute to a better quality of life and improve the quality of care.

In CKD, symptom burden is better understood when capturing the multidimensional aspects of a range of physical and psychological symptoms. Fatigue, pain and sexual dysfunction are key contributors to symptom burden, and these symptoms are often under-recognised and warrant routine assessment. The CKD-SBI offers a valuable tool for renal clinicians to assess symptom burden, leading to the commencement of timely and appropriate interventions.

Adopting a symptom cluster approach has the potential to significantly advance symptom assessment and nursing care for people in advanced stages of chronic kidney disease. Routine clinical assessment and management strategies targeted at the cluster level should have synergistic effects in reducing symptoms. Fatigue is a pervasive symptom in advanced chronic kidney disease that is interconnected with global symptom burden, suggesting better management of symptom clusters may also reduce fatigue.

Interventions targeting symptom clusters could greatly improve quality of life in patients with chronic kidney disease. The symptom cluster model presented has important clinical and heuristic implications, serving as a framework to encourage and guide new lines of intervention research to reduce symptom burden in chronic kidney disease.

BackgroundSymptom burden in chronic kidney disease (CKD) is poorly understood. To date, the majority of research focuses on single symptoms and there is a lack of suitable multidimensional symptom measures. The purpose of this study was to modify, translate, cross-culturally adapt and psychometrically analyse the Dialysis Symptom Index (DSI).MethodsThe study methods involved four phases: modification, translation, pilot-testing with a bilingual non-CKD sample and then psychometric testing with the target population. Content validity was assessed using an expert panel. Inter-rater agreement, test-retest reliability and Cronbach’s alpha coefficient were calculated to demonstrate reliability of the modified DSI. Discriminative and convergent validity were assessed to demonstrate construct validity.ResultsContent validity index during translation was 0.98. In the pilot study with 25 bilingual students a moderate to perfect agreement (Kappa statistic = 0.60-1.00) was found between English and Arabic versions of the modified DSI. The main study recruited 433 patients CKD with stages 4 and 5. The modified DSI was able to discriminate between non-dialysis and dialysis groups (p < 0.001) and demonstrated convergent validity with domains of the Kidney Disease Quality of Life short form. Excellent test-retest and internal consistency (Cronbach’s α = 0.91) reliability were also demonstrated.ConclusionThe Arabic version of the modified DSI demonstrated good psychometric properties, measures the multidimensional nature of symptoms and can be used to assess symptom burden at different stages of CKD. The modified instrument, renamed the CKD Symptom Burden Index (CKD-SBI), should encourage greater clinical and research attention to symptom burden in CKD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0036-2) contains supplementary material, which is available to authorized users.

Reporting of medication administration errors (MAEs) is one means by which health care facilities monitor their practice in an attempt to maintain the safest patient environment. This study examined the likelihood of registered nurses (RNs) reporting MAEs when working in Saudi Arabia. It also attempted to identify potential barriers in the reporting of MAE. This study found that 63% of RNs raised concerns about reporting of MAEs in Saudi Arabia-nursing administration was the largest impediment affecting nurses' willingness to report MAEs. Changing attitude to a non-blame system and implementation of anonymous reporting systems may encourage a greater reporting of MAEs.

Knowledge is critical for self- management, however there are no measures available in Arabic to effectively assess knowledge and self-management for chronic kidney disease (CKD). The aim of this study was to translate, culturally adapt, and validate Chronic Kidney Disease Self-Management Instrument-29 (CKD-SM-29) and Kidney Disease Knowledge survey (KiKs) for use by Arabic-speaking health professionals and patients. The study was carried out in two phases: translation and cultural adaptation, and validation. Instruments were translated from English to Arabic then adapted and validated using 203 pre-dialysis CKD patients. Face validity and internal consistency were demonstrated for Arabic versions of CKD-SM-29 and KiKs. Cronbach’s α for the CKD-SM-29 was .91 for KiKS was .78. Test-retest revealed good stability over a 1-week period. Intra Class Correlation coefficient for CKD-SM-29 was .90 and was .78 for KiKS. Convergent and discriminative validity were also demonstrated for the translated instruments. The validity and reliability of the Arabic CKD-SM-29 and KiKs were demonstrated. The translated instruments are culturally adapted and will support care of patients with CKD in Arabic-speaking countries.

Aims and objectives:This study aimed to assess the impact of anxiety and depression on the quality of life (QOL) of haemodialysis patients. Background:The growing number of people undergoing haemodialysis therapy on a global scale is becoming a universal concern. Although haemodialysis treatment is known to affect one's psychological well-being, the impact of depression and anxiety on one's QOL has not been well addressed.Design: A correlational cross-sectional design.Methods: A convenience sample of 114 patients who had been undergoing haemodialysis therapy participated in this study. The research methods used complied with the STROBE checklist. Data were collected using the Kidney Disease and Quality of Life Survey-36 and the Hospital Anxiety and Depression Scale. Descriptive and inferential statistics were used. The association between the KDQOL, anxiety and depression based on the characteristics of participants was investigated using an independent t test and one-way analysis of variance. Results:The mean anxiety score of the participants was 7.7 ± 5.3, while the mean score for depression was 7.01 ± 4.2. Based on the cut-off points, 50% of the participants had anxiety, 44.7% depression. There were negative correlations between anxiety and QOL (r = −0.599, p < 0.001) and between depression and QOL (r = −.599, p < .001). The burden of the disease and physical component scores were mostly affected by both anxiety and depression.Conclusions: Anxiety and depression are common symptoms among patients undergoing haemodialysis, and they have a negative impact on all domains of the QOL.Early detection and treatment of anxiety and depression may have a positive impact on disease outcomes. Relevance to clinical practice:The findings of the current study support the need to adopt effective strategies to improve screening for anxiety and depression. The detection of high physical symptom burden should draw attention to potential psychological issues.