Intradialytic Symptoms and Recovery Time in Patients on Thrice-Weekly In-Center Hemodialysis: A Cross-sectional Online Survey

Abstract

Rationale & Objective Patients experience various symptoms during hemodialysis. We aimed to assess the frequency and severity of symptoms during hemodialysis and whether intradialytic symptoms are associated with recovery time postdialysis. Study Design An online questionnaire was sent to 10,000 patients in a National Kidney Foundation database. Setting & Participants Adult patients receiving in-center hemodialysis 3 times weekly for 3 or more months. Exposure Online questionnaire. Analytic Approach Tabulation of frequency and severity of events and recovery time as percent of respondents, construction of a total symptom score, followed by rank correlation analysis of symptom characteristics with total recovery time. Outcomes Patient-reported intradialytic symptoms and recovery time postdialysis. Results 359 patients met screening criteria and completed the questionnaire. Mean age was 62.5 ± 13.8 years, 207 (58%) were men, 74 (21%) were black/African American, 132 (37%) had diabetes, 252 (70%) had hypertension, and 102 (28%) had a history of myocardial infarction, heart surgery, or stent placement. 311 (87%) patients had symptoms during dialysis in the previous week, with mean severity of 2.7 (range for each symptom, 1-5). The most common symptoms were fatigue/feeling washed out (62%), cramps (44%), and symptoms of low blood pressure (42%). Median time to recovery was 3 (range, 0-24) hours, and this correlated with the incidence and severity of intradialytic symptoms ( P < 0.0001). 40% of patients had time to recovery times of 4 hours or longer. 1 in 3 patients reported having stopped dialysis early for intradialytic symptoms and 6% reported skipping dialysis at least once because of intradialytic symptoms. Limitations Recall-based self-reported data with a relatively low response rate. Conclusions A majority of patients receiving in-center hemodialysis experience symptoms such as feeling washed out, fatigue, and cramping; these may be severe and are correlated with longer recovery time following hemodialysis, as well as shortened and skipped hemodialysis sessions.

Dialysate Magnesium and Coronary Artery Calcification, Bone Mineral Density, and Cramping in Maintenance Hemodialysis: A Quasi-experimental Study

“…Muscle cramping is the second most common intradialytic symptom after hypotension. The discomfort produced by these intradialytic symptoms could be the cause of early cessation of HD session in up to 30% of the patients 32,33 . In the present study, the number of patients and episodes of muscle cramps during HD were remarkably lower among those who received high dialysis magnesium.…”

Intradialytic Symptoms and Recovery Time: Thinking ‘Outside the Box’ to Improve Patients’ Dialysis Experience

“…12 Although factors such as age and sex are nonmodifiable, dialysis prescriptions are usually modified to address physiologic factors such as rapid fluid and electrolyte shifts and changes in plasma osmolality. 1 Future strategies may include real-time adjustments in prescription informed by both objective data and patient-reported symptoms. However, objective data alone may not be sufficient to develop the most precise and accurate predictive symptom model, and other psychological, social, and cultural determinants affecting the expression of intradialytic symptoms must also be considered.…”

“…It is saddening that despite efforts to improve dialysis technology during the past 3 decades, 8 dialysis patients continue to experience severe symptoms with significant frequency during and after their dialysis treatments. 1 As shown by Alvarez et al, this symptom burden lengthens the duration of dialysis recovery time, promotes nonadherence to dialysis treatments, 1 and also results in increased hospitalization and mortality rates. 9 Efforts to assess and address symptoms during hemodialysis, including traditional clinical practice approaches, have not made sufficient impact.…”

“…In this issue of Kidney Medicine , Alvarez et al, 1 using responses to a National Kidney Foundation scientific survey, present an informative and timely study detailing self-reported symptoms during in-center hemodialysis and associations between symptoms experienced during dialysis with recovery time after dialysis treatments. Dialysis recovery time is an important concept that encapsulates challenges experienced by dialysis patients contributing to impaired health-related quality of life.…”

Real-time prediction of intradialytic relative blood volume: a proof-of-concept for integrated cloud computing infrastructure

“…This process helps preserve blood pressure and tissue perfusion [ 2 ]. However, inadequate refilling could lead to a variety of intradialytic symptoms, such as intradialytic hypotension (IDH), fatigue, and cramping [ 3 , 4 ]. IDH can lead to cardiac complications and an increased risk of death [ 5 – 8 ].…”