Symptom Clusters in Patients on Dialysis and Their Association With Quality‐of‐life Outcomes

Amro, Amin; Waldum, Bård; Dammen, Toril; Miaskowski, Christine; Os, Ingrid

doi:10.1111/jorc.12051

Cited by 56 publications

(134 citation statements)

References 33 publications

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“…Some data are available on symptom clusters in patients with HIV disease (10,11), chronic kidney failure and endstage renal disease (15,16), COPD (12,13), osteoarthritis (45), rheumatoid arthritis (46), and heart failure (14). Similar to studies in oncology, the occurrence of symptom clusters in these chronic conditions is associated with decrements in functional status and QOL, as well as increased health care utilization and mortality.…”

Section: Transferability To Other Chronic Conditionsmentioning

confidence: 82%

“…While the psychiatric literature provides excellent examples of the use of hierarchical cluster analysis to define subgroups of patients within a diagnostic subgroup (for examples, see 5-7) or as diagnostic criteria (for examples, see 8,9), the majority of the research on symptom clusters in patients with chronic conditions was conducted with oncology patients. However, an emerging body of evidence suggests that symptom clusters occur in patients with a variety of chronic conditions (eg, HIV disease [10,11], chronic obstructive pulmonary disease [COPD] [12,13], heart disease [14], end-stage renal disease [ESRD] [15,16]). Nonetheless, research on symptom clusters is extremely limited.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations

Miaskowski

Barsevick

Berger

et al. 2017

JNCI J Natl Cancer Inst

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328

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An overview of proceedings, findings, and recommendations from the workshop on "Advancing Symptom Science Through Symptom Cluster Research" sponsored by the National Institute of Nursing Research (NINR) and the Office of Rare Diseases Research, National Center for Advancing Translational Sciences, is presented. This workshop engaged an expert panel in an evidenced-based discussion regarding the state of the science of symptom clusters in chronic conditions including cancer and other rare diseases. An interdisciplinary working group from the extramural research community representing nursing, medicine, oncology, psychology, and bioinformatics was convened at the National Institutes of Health. Based on expertise, members were divided into teams to address key areas: defining characteristics of symptom clusters, priority symptom clusters and underlying mechanisms, measurement issues, targeted interventions, and new analytic strategies. For each area, the evidence was synthesized, limitations and gaps identified, and recommendations for future research delineated. The majority of findings in each area were from studies of oncology patients. However, increasing evidence suggests that symptom clusters occur in patients with other chronic conditions (eg, pulmonary, cardiac, and end-stage renal disease). Nonetheless, symptom cluster research is extremely limited and scientists are just beginning to understand how to investigate symptom clusters by developing frameworks and new methods and approaches. With a focus on personalized care, an understanding of individual susceptibility to symptoms and whether a "driving" symptom exists that triggers other symptoms in the cluster is needed. Also, research aimed at identifying the mechanisms that underlie symptom clusters is essential to developing targeted interventions.Patients with chronic conditions, such as cancer and other rare diseases, experience an array of multiple co-occurring symptoms (eg, pain, fatigue, sleep disturbance). When these symptoms remain underdiagnosed and undertreated, they have a negative impact on patient-reported outcomes (PROs) including functional performance, cognitive status, and quality of life (QOL). A reduction in symptom burden in these patients has the potential to improve their capacity to live well over their entire lives. To achieve this goal, a transformation is needed in how multiple co-occurring symptoms are assessed and managed in order to improve patient outcomes and stimulate a reduction in health care utilization and costs. A strategic plan that advances REVIEW

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Section: Transferability To Other Chronic Conditionsmentioning

confidence: 82%

mentioning

confidence: 99%

Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations

Miaskowski

Barsevick

Berger

et al. 2017

JNCI J Natl Cancer Inst

Self Cite

328

330

View full text Add to dashboard Cite

show abstract

“…Beyond foot lesions and their sequelae, peripheral neuropathy can have a debilitating effect on the quality of life and physical function, a relationship that is also evident in dialysis patients . In a study of 301 dialysis patients, neuromuscular symptoms were independently associated with reduced self‐reported physical function and increased depressive symptoms. Another study reported a significant reduction in gait speed that was negatively correlated with the severity of peripheral neuropathy and greater difficulty in activities of daily living …”

Section: Implications Of Peripheral Neuropathy In Ckdmentioning

confidence: 99%

Potassium control in chronic kidney disease: implications for neuromuscular function

Arnold

Pianta

Pussell

et al. 2019

Internal Medicine Journal

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In Australia approximately 1.7million adults have evidence of chronic kidney disease (CKD). This complex disease can result in a multitude of complications, including hyperkalaemia which common and well recognised. . The advent of new therapeutics aimed at lowering serum potassium have raised the possibility of optimising potassium control to enable greater use of renin-angiotensin-aldosterone system inhibitors in the management of CKD. Recent studies suggest that hyperkalaemia also has implications for peripheral neuropathy in CKD, a complication that substantially contributes to patient morbidity. This review examines evidence of the relationship between potassium and peripheral neuropathy with discussion of clinical implications. We searched PubMed for original and review articles using prespecified key words, clinical guidelines and population data. The major findings were that contemporary CKD cohorts demonstrate a high prevalence of peripheral neuropathy, even in stage 3-4 CKD, including those without diabetes. The severity of the problem has been emphasized by an ominous rise in foot complications and amputation rates in dialysis patients, highlighting the need for increased awareness of the condition in earlier stages of CKD and targeted treatment strategies. It is likely that the pathophysiology of peripheral neuropathy in CKD is multifaceted with potential influences from potassium, vascular abnormalities, diabetes, inflammation and unknown middle molecules. Despite these complexities, the relationship between potassium and nerve function in dialysis has been well established and recent research in stage 3-4 CKD suggests that assertive potassium control may improve neuromuscular outcomes in CKD. These small studies should be confirmed in large, multicenter settings. This article is protected by copyright. All rights reserved.

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“…Preliminary research also suggests that pain is associated with impaired HR-QOL. 45,46 Davison et al assessed pain using the Edmonton Symptom Assessment Scale and HR-QOL using the Kidney Disease Quality of Life Short Form (KDQOL-SF) on two occasions 6 months apart among 591 patients on chronic dialysis. 45 Similar to the SF-12 used in the current study, the KDQOL-SF generates PCS and MCS scores ranging from 0 to 100.…”

Section: Sacks Et Al Assessed Depression and Hr-qol With The Beck Dementioning

confidence: 99%

Longitudinal associations of depressive symptoms and pain with quality of life in patients receiving chronic hemodialysis

Belayev

Mor

Sevick

et al. 2014

Hemodialysis International

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Background Depressive symptoms and pain are common in patients on chronic hemodialysis (HD), yet their associations with quality of life (QOL) are not fully understood. We sought to characterize the longitudinal associations of these symptoms with QOL. Methods As part of a trial comparing two symptom management strategies in patients receiving chronic HD, we assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and pain using the Short-Form McGill Pain Questionnaire (SF-MPQ) monthly over 24 months. We assessed health-related QOL (HR-QOL) quarterly using the Short Form 12 (SF-12) and global QOL (G-QOL) using a single item survey. We used random effects linear regression to analyze the independent associations of depressive symptoms and pain, scaled based on 5 point increments in symptom scores, with HR-QOL and G-QOL. Results Overall, 286 patients completed 1,417 PHQ-9 and SF-MPQ symptom assessments, 1,361 SF-12 assessments, and 1,416 G-QOL assessments. Depressive symptoms were independently and inversely associated with SF-12 physical HR-QOL scores (β= -1.09; 95% CI: -1.69, -0.50, p<0.001); SF-12 mental HR-QOL scores (β= -4.52; 95%CI: -5.15, -3.89, p<0.001); and G-QOL scores (β= -0.64; 95%CI: -0.79, -0.49, p<0.001). Pain was independently and inversely associated with SF-12 physical HR-QOL scores (β= -0.99; 95% CI: -1.30, -0.68, p<0.001) and G-QOL scores (β= -0.12; 95%CI: -0.20, -0.05, p=0.002); but not with SF-12 mental HR-QOL scores (β= -0.16; 95%CI: -0.050, 0.17, p=0.34). Conclusion In patients receiving chronic HD, depressive symptoms and to a lesser extent pain, are independently associated with reduced HR-QOL and G-QOL. Interventions to alleviate these symptoms could potentially improve patients' HR-QOL and G-QOL.

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Symptom Clusters in Patients on Dialysis and Their Association With Quality‐of‐life Outcomes

Cited by 56 publications

References 33 publications

Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations

Advancing Symptom Science Through Symptom Cluster Research: Expert Panel Proceedings and Recommendations

Potassium control in chronic kidney disease: implications for neuromuscular function

Longitudinal associations of depressive symptoms and pain with quality of life in patients receiving chronic hemodialysis

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