Undertreatment of Symptoms in Patients on Maintenance Hemodialysis

Claxton, René; Blackhall, Leslie; Weisbord, Steven D.; Holley, Jean Lake

doi:10.1016/j.jpainsymman.2009.07.003

Cited by 128 publications

(123 citation statements)

References 25 publications

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“…[41] Many of these symptoms are undertreated, often owing to a general lack of proper treatment for HD symptoms. [42] In particular, even if pain represents a constant concern among health professionals, strategies to reduce pain in HD patients still seem wanting. [42,43] In part this is due to organizational uncertainty about who, the nurse or the physician, is responsible for treating symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…[42] In particular, even if pain represents a constant concern among health professionals, strategies to reduce pain in HD patients still seem wanting. [42,43] In part this is due to organizational uncertainty about who, the nurse or the physician, is responsible for treating symptoms. [44] Further to these results, healthcare professionals should assess presence of pain in HD patients systematically and propose pharmacological and non-pharmacological solutions to remedy the situation.…”

Section: Discussionmentioning

confidence: 99%

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Symptoms and quality of life from patients undergoing hemodialysis in Switzerland

Delmas¹,

Cohen²,

Loiselle

et al. 2017

CNS

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Background: Dialysis patients experience multiple symptoms impairing their quality of life. A relationship seems to exist between the cultural context and the burden of symptoms. In this study, the prevalence and severity of 30 symptoms and their relationship with quality of life among hemodialysis patients in Switzerland is explored. Methods: A cross-sectional correlation design was used with a convenience sample of 119 patients from five dialysis units. Presence and severity of symptoms were assessed with the Dialysis Symptom Index and quality of life with the WHOQOL-Bref questionnaire. Multivariate linear regressions were used to examine the relationship between the prevalence and severity of symptoms, respectively, and quality of life. T-tests and Fisher's tests were used for the international comparisons. Results: On average, patients reported 10 symptoms and often rated these as "somewhat bothersome". The most frequent were: lack of energy, dry skin, trouble falling asleep, trouble staying asleep, and muscle cramps. Average symptoms prevalence and severity levels were both observed to decrease patients' quality of life, items related to physical health and psychological state having the greatest impact. Prevalence and severity of psychological symptoms and prevalence of sex-related symptoms seem to be influenced by patients' cultural context. Conclusions: These results demonstrate that patients on chronic hemodialysis present several symptoms that affect their quality of life. Healthcare professionals should develop strategies to identify more properly these symptoms, especially sex-related and psychological symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Symptoms and quality of life from patients undergoing hemodialysis in Switzerland

Delmas¹,

Cohen²,

Loiselle

et al. 2017

CNS

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show abstract

“…In the aforementioned dialysis patient survey, 84% of patients thought it extremely important or at least somewhat important to have their symptoms treated (9). Symptoms are commonly undertreated in this population (33), including pain, despite demonstrated efficacy of the World Health Organization analgesic ladder in patients with ESRD (34). The potential for pharmacologic or psychosocial treatment of these problems notwithstanding, patients with deteriorating clinical status may perceive that the benefits of life-sustaining treatment with dialysis are not worth its burdens.…”

Section: Recognizing Changes In Benefit-burden Balancementioning

confidence: 99%

Dying on Dialysis

Schmidt

Moss

2014

Clinical Journal of the American Society of Nephrology

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SummaryAcceleration of comorbid illness in patients undergoing long-term maintenance hemodialysis may be manifested by clinical deterioration that is subtle and not immediately life-threatening. Nonetheless, it is emotionally debilitating for patients and families in addition to being medically and ethically challenging for treating nephrologists. A marked decline in clinical status warrants review of the balance of benefits to burdens dialysis is providing to a given patient and should trigger conversation about the option of withdrawal using an individualized patient-centered, rather than disease-oriented, approach. This paper presents a rationale for and an objective approach to initiating and managing dialysis withdrawal for patients who wish to withdraw because of unsatisfactory quality of life and those (many with significant cognitive impairment) for whom withdrawal is deemed appropriate because the burdens of continuing treatment substantially outweigh the benefits.

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“…Despite evidence of the benefit of opioid analgesics (6) and the availability of opioid prescribing guidelines in ESKD (6)(7)(8)(9), several studies have suggested that pain is inadequately treated in patients on hemodialysis (10)(11)(12)(13)(14)(15)(16), and provider concern for adverse drug effects may present a barrier to effective pain management (10,13). However, it is plausible that patients on hemodialysis may be especially susceptible to opioid-related complications due to multiple comorbidities, polypharmacy, superimposed uremia, and reduced clearance by the kidney of active drug metabolites, and therefore, caution in their use may be warranted (10,17).…”

Section: Introductionmentioning

confidence: 99%

Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients

Ishida

McCulloch

Steinman

et al. 2018

CJASN

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Background and objectives Patients on hemodialysis frequently experience pain and may be particularly vulnerable to opioid-related complications. However, data evaluating the risks of opioid use in patients on hemodialysis are limited.Design, setting, participants, & measurements Using the US Renal Data System, we conducted a cohort study evaluating the association between opioid use (modeled as a time-varying exposure and expressed in standardized oral morphine equivalents) and time to first emergency room visit or hospitalization for altered mental status, fall, and fracture among 140,899 Medicare-covered adults receiving hemodialysis in 2011. We evaluated risk according to average daily total opioid dose (.60 mg, #60 mg, and per 60-mg dose increment) and specific agents (per 60-mg dose increment).Results The median age was 61 years old, 52% were men, and 50% were white. Sixty-four percent received opioids, and 17% had an episode of altered mental status (15,658 events), fall (7646 events), or fracture (4151 events) in 2011. Opioid use was associated with risk for all outcomes in a dose-dependent manner: altered mental status (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.23 to 1.34; higher dose: hazard ratio, 1.67; 95% confidence interval, 1.56 to 1.78; hazard ratio, 1.29 per 60 mg; 95% confidence interval, 1.26 to 1.33), fall (lower dose: hazard ratio, 1.28; 95% confidence interval, 1.21 to 1.36; higher dose: hazard ratio, 1.45; 95% confidence interval, 1.31 to 1.61; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.03 to 1.05), and fracture (lower dose: hazard ratio, 1.44; 95% confidence interval, 1.33 to 1.56; higher dose: hazard ratio, 1.65; 95% confidence interval, 1.44 to 1.89; hazard ratio, 1.04 per 60 mg; 95% confidence interval, 1.04 to 1.05). All agents were associated with a significantly higher hazard of altered mental status, and several agents were associated with a significantly higher hazard of fall and fracture.Conclusions Opioids were associated with adverse outcomes in patients on hemodialysis, and this risk was present even at lower dosing and for agents that guidelines have recommended for use.

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Undertreatment of Symptoms in Patients on Maintenance Hemodialysis

Cited by 128 publications

References 25 publications

Symptoms and quality of life from patients undergoing hemodialysis in Switzerland

Symptoms and quality of life from patients undergoing hemodialysis in Switzerland

Dying on Dialysis

Opioid Analgesics and Adverse Outcomes among Hemodialysis Patients

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