Differences in physical symptoms between those with and without kidney disease: a comparative study across disease stages in a UK population

Abstract

Background Those living with kidney disease (KD) report extensive symptom burden. However, research into how symptoms change across stages is limited. The aims of this study were to 1) describe symptom burden across disease trajectory, and 2) to explore whether symptom burden is unique to KD when compared to a non-KD population. Methods Participants aged > 18 years with a known diagnosis of KD (including haemodialysis (HD) and peritoneal dialysis (PD)) and with a kidney transplant) completed the Leicester Kidney Symptom Questionnaire (KSQ). A non-KD group was recruited as a comparative group. Multinominal logistic regression modelling was used to test the difference in likelihood of those with KD reporting each symptom. Results In total, 2279 participants were included in the final analysis (age 56.0 (17.8) years, 48% male). The main findings can be summarised as: 1) the number of symptoms increases as KD severity progresses; 2) those with early stage KD have a comparable number of symptoms to those without KD; 3) apart from those receiving PD, the most frequently reported symptom across every other group, including the non-KD group, was ‘feeling tired’; and 4) being female independently increased the likelihood of reporting more symptoms. Conclusions Our findings have important implications for patients with KD. We have shown that high symptom burden is prevalent across the spectrum of disease, and present novel data on symptoms experienced in those without KD. Symptoms requiring the most immediate attention given their high prevalence may include pain and fatigue. Trial registration The study was registered prospectively as ISRCTN11596292.

Symptom Burden before and after Dialysis Initiation in Older Patients

“…Patients with CKD stage 4-5 have a high symptom burden and may suffer from six to 20 kidney failure-related symptoms (29). This symptom burden increases by 0.5-2.9 symptoms as kidney function declines (27,30,31). An increase in symptom burden may negatively affect HRQOL and is associated with a combined poor health outcome of starting dialysis, receiving a kidney transplant, or death (5,31).…”

Predictors of somatic symptom persistence in patients with chronic kidney disease (SOMA.CK): study protocol for a mixed-methods cohort study

“…Recent research suggests the high prevalence and relevance of PSS in non-dialysis CKD 4 6–9. Yet, the determinants of symptom burden in CKD remain yet to be understood.…”

“…The most prevalent and disabling symptoms are fatigue, sleep disturbance, bone or joint pain, frailty and pruritus (figure 1). 4 6–9 The mean number of symptoms per individual ranges from 6 to 20 across studies 7. Patients often report disabling somatic symptoms to be the core disease burden in their lives 10.…”

Fatigue in Systemic Lupus Erythematosus and Rheumatoid Arthritis: A Comparison of Mechanisms, Measures and Management

“…Most organ involvement in SLE contributes, to some extent, to a patient's overall fatigue, partially explaining its high prevalence. The most frequently self-reported symptom in patients with kidney disease is fatigue, affecting up to two-thirds of non-dialysis patients and being associated with factors such as comorbidity burden, anaemia and the use of anti-depressants [47,48]. The latter may reflect the mental health burden in chronic disease manifesting as fatigue.…”