SUMMARY
Background
Studies indicate that symptoms attributable to impaired kidney function are important determinants of quality of life and functional status in patients with chronic kidney disease (CKD). Accordingly, symptom assessment and subsequent control are prerequisites of high‐quality care in this patient population. Whilst symptom burden in patients with advanced CKD managed without dialysis has been likened to that of palliative care cancer populations, there is little information about the nature and range of symptoms in earlier stages of the CKD trajectory. This paper reports the findings of the preliminary phase of a study aimed at exploring the symptom experience in patients with CKD stages 4 and 5.
Methods
Eighteen semi‐structured patient interviews were conducted, using an interview schedule developed specifically to guide discussion. Data were analysed using thematic analysis to identify symptom categories and thematic patterns across the patient experiences.
Results
Patients reported a wide range of symptoms, with over 50 different categories and sub‐categories emerging from the interview data. Symptom categories could be broadly classified into physical symptoms, such as ‘Altered taste perception’, ‘Sleep disturbance’ and ‘Fatigue’, and psychological symptoms, such as ‘Forgetfulness’, ‘Poor concentration’ and ‘A sensation of gradually slowing down’. Of note, when questioned further, patients indicated that they would not usually report their symptoms to clinicians.
Conclusions
This study suggests that patients with CKD stages 4 and 5 may have a high symptom burden. The finding that patients did not routinely report their symptoms emphasises a need for clinicians to incorporate symptom assessment into routine clinical consultations.
Anaemia due to chronic kidney disease (CKD) is common and may be managed with erythropoiesis stimulating agents and/or iron preparations. Iron preparations may be administered orally, intravenously or by intramuscular injection. Oral preparations pose a significant tablet burden on patients who are often taking multiple medications and may have undesirable gastrointestinal side effects. The existing intravenous preparation Venofer requires multiple doses of drug (typically 100-200 mg) at multiple clinic visits. The preparation Cosmofer may be given as a single dose, but this requires four to six hours to administer. For these reasons, their use in pre-dialysis patients remains limited in practice. The new intravenous iron preparation Ferric Carboxymaltose (Ferinject) may be given as a single dose of up to 1000 mg (but not exceeding 15 mg/kg/week) as an infusion over 6-15 minutes. This offers a significant advance in the management of these patients. We describe our initial experience with using this drug in a non-dialysis patient population with chronic kidney disease.
QOL is already impaired in moderate CKD. The significant difference in QOL and symptom intrusiveness between the moderate CKD and NRF groups may denote a causal relationship between symptom intrusiveness and QOL early in CKD.
This follows on from an article relating to chronic kidney disease (CKD) and co-morbidities. Not only do these co-morbid diseases cause problems to patients with CKD, they continue to impact upon them when they develop established renal failure (ERF). Various co-morbid conditions can affect the patient including diabetes, hypertension, anaemia and cardiovascular issues. As nephrology nurses we play a fundamental role in patient education, monitoring and management of these factors.
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