Physical Symptom Cluster Subgroups in Chronic Kidney Disease

Abstract

Background: Symptom burden associated with chronic kidney disease can be debilitating, with a negative effect on patient health-related quality of life. Latent class clustering analysis is an innovative tool for classifying patient symptom experience. Objectives: The aim of the study was to identify subgroups of patients at greatest risk for high symptom burden, which may facilitate development of patient-centered symptom management interventions. Methods: In this cross-sectional analysis, baseline data were analyzed from 3,921 adults enrolled in the Chronic Renal Insufficiency Cohort Study from 2003 to 2008. Latent class cluster modeling using 11 items on the Kidney Disease Quality of Life symptom profile was employed to identify patient subgroups based on similar observed physical symptom response patterns. Multinomial

Patient-centred approaches for the management of unpleasant symptoms in kidney disease

“…Stage 5D, dialysis; stage 5T, transplant. those suffering from most chronic diseases, including CKD, occur in clusters 1,19,34,35 .…”

“…A greater understanding of the potential biological mechanisms underlying common symptoms reported by individuals with CKD is essential for identifying targeted interventions that lessen symptom burden and improve quality of life. As symptoms often occur in clusters, they may also share a common biological aetiology 1,19,30,34 . For example, a psychoneurological symptom cluster (for example, involving pain, fatigue, anxiety, depression, pain, sleep disturbance and cognitive dysfunction) has been consistently observed among patients with cancer -a population that has a similar level of symptom experience to that of patients with advanced CKD [57][58][59][60] .…”

“…The critical role of patient-centredness in the management of all disease states, including chronic kidney disease (CKD), has gained increased recognition in the past decade 1,2 . This turning point has led to heightened interest in symptom science, and in the field of nephrology, a focus on effective symptom management 3 .…”

“…However, symptom burden can adversely affect the quality of life of patients with kidney disease, particularly when combined with regimented management approaches, including dietary and fluid restrictions, high pill burden and strict dialysis schedules 8 . Hence, a major unmet need exists for effective symptom management in CKD, as a means of alleviating patient suffering, improving quality of life and ensuring the overarching goal of living well with kidney disease 1 . In this Perspective, we examine the concept and scope of symptom burden in CKD; theoretical frameworks and constructs for symptom science; biological mechanisms underlying some of the unpleasant symptoms associated with CKD; validated tools for symptom appraisal and assessment; and strategies for symptom management, including palliative care approaches for patients with CKD under conservative management or receiving kidney replacement therapy.…”

Novel approach to unpleasant symptom clusters surrounding pruritus in patients with chronic kidney disease and on dialysis therapy

“…However, symptom cluster science across the spectrum of CKD is in its infancy and more research is needed to untangle the complex relationships between symptoms and patient outcomes. Identification of symptom clusters among patients with ESKD undergoing dialysis may help inform symptom assessment, risk-stratification, and development of patient-centered interventions to reduce symptom burden, thereby reducing the negative impact on patient HRQoL [ 10 ▪ ].…”