Changes in Symptom Burden in Dialysis Patients Assessed Using a Symptom-Reporting Questionnaire in Clinic

Abstract

Introduction: To determine the prevalence, severity, and change in symptoms experienced by dialysis patients following the introduction of use of a symptom-reporting questionnaire in nephrology clinic. Methods: This is an observational study of 160 prevalent dialysis patients. Palliative care Outcome Scale symptom (POS-renal) questionnaires modified for patients with end-stage kidney disease were completed at baseline and follow-up (median 3 months), with results available to nephrologists at clinic appointments. Findings: The baseline prevalence of individual symptoms ranged from 15% to 66%. The most common symptoms were lack of energy (66%) and poor mobility (58%). The median number of symptoms was 7/17 (interquartile range [IQR]: 4-10). Forty-nine percent of patients rated at least 1 symptom as severe or overwhelming. At follow-up, the median number of symptoms experienced was unchanged at 7/17 (IQR: 3-10). However, there was considerable flux in symptom severity. On average, individual symptoms that were present at baseline improved in 56% of patients and worsened in 18%; only 26% had stable symptom severity. Individual symptoms newly occurred in 8% to 20% of patients between time points, with 77% of patients experiencing at least 1 new symptom. The percent of patients rating at least 1 symptom as severe or overwhelming was reduced from 49% to 39% ( P = .040). Conclusions: Use of the POS-renal questionnaire identified a high symptom burden. The presence and severity of symptoms changed dramatically over a short follow-up period, highlighting the need for regular surveillance of symptoms in the dialysis population. Routine use of a symptom questionnaire in clinic may be useful for the identification and management of symptoms in dialysis patients.

Como incluir os cuidados paliativos na formação de médicos nefrologistas: Revisão da literatura

“…Em geral, a abordagem dos sintomas deve envolver a avaliação da causa, fatores reversíveis, nível de sofrimento ou disfunção causada, opções de intervenções não farmacológicas e farmacológicas, gerenciamento de expectativas e reconhecimento das limitações da terapia (Gelfand et al, 2020). Para facilitar a identificação e tratamento de sintomas em pacientes em diálise e/ou tratamento conservador recomenda-se o uso rotineiro de um questionário previamente estruturado, como o IPOSs-renal -Escala Integrada de Resultados de Cuidados Paliativos (Moskovitch, Mount & Davies, 2019).…”

“…A versão renal da Escala Integrada de Resultados de Cuidados Paliativos (IPOS-renal) compreende a investigação de 17 sintomas físicos, sintomas emocionais e avaliação da comunicação e outros problemas práticos relacionados à DRC (Gelfand et al, 2020;Moskovitch et al, 2019). Estudos realizados na Austrália e Estados Unidos, entre os anos de 2015 e 2016, demonstram uma variação de 6 a 17 sintomas relatados na aplicação do questionário, porém esse número varia a depender das comorbidades associadas, da ferramenta de avaliação usada e do momento da medição (Moskovitch et al, 2019;Song, 2016).…”

“…Vários sintomas podem ser difíceis de ser manejados se tratados isoladamente, logo faz-se necessário avaliações frequentes e cuidadosas para atingir as metas do tratamento. A exemplo disso a adequação da diálise para sessões mais frequentes, porém mais curtas, pode ser mais aceitável para alguns pacientes, pois sintomas como distúrbios do sono, dificuldade respiratória e fadiga pós-diálise podem ser atenuados (Davison & Jassal, 2016;Moskovitch et al, 2019).…”

“…Estudos de prevalência realizados no Reino Unido e Austrália, entre os anos de 2016 e 2017, descreveram a predominância de sintomas (fadiga ou falta de energia, baixa mobilidade, insônia, prurido, dor, dispneia e falta de apetite) em grupos de pacientes em hemodiálise ou em tratamento conservador. (Moskovitch et al, 2019;Siriwardana et al, 2020;Song, 2016). Do estudo em pacientes em diálise na Austrália em 2017, 53% dos pacientes sentiu-se deprimido e 54% sentiu-se ansioso (Siriwardana et al, 2020).…”

A cluster randomized controlled trial for the Evaluation of routinely Measured PATient reported outcomes in HemodialYsis care (EMPATHY): a study protocol

“…These symptoms are often under-recognized by kidney care teams, which may be related to breakdown in communication [7]. In a recent priority setting exercise, the top research priority for patients with kidney failure requiring dialysis in Canada was to enhance communication between patients and clinicians to maximize patient participation in decision making and facilitate self-management [8]. Furthermore, five of the top 10 research priorities for patients with kidney failure requiring dialysis focus on reducing symptoms and improving HRQL [6].…”