Which Patients With Chronic Kidney Disease Have the Greatest Symptom Burden? A Comparative Study of Advanced CKD Stage and Dialysis Modality

Almutary, Hayfa; Bonner, Ann; Douglas, Clint

doi:10.1111/jorc.12152

Cited by 114 publications

(165 citation statements)

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“…It has been shown in multiple studies of hemodialysis patients that older age is associated with fatigue [2,10], so our sample weighted toward older patients may have overestimated fatigue presence in CKD-ND patients. Female sex has also been associated with fatigue [10], with women most frequently reporting fatigue and bone/joint pain as severe symptoms in one study of CKD-ND patients with an incident eGFR ≤20 mL/ min/1.73 m 2 [40]. We were unable to evaluate sex-based differences in our study comprised predominantly of men.…”

Section: Discussionmentioning

confidence: 97%

“…In addition, data on the prevalence of fatigue symptoms and related clinical factors are scarce in patients with nondialysis CKD (CKD-ND) [4,10], a stage of disease at which earlier intervention may affect long-term outcomes. Importantly, no prospective studies have evaluated the association of fatigue with outcomes in this patient population.…”

Section: Introductionmentioning

confidence: 99%

“…In patients with CKD-D, fatigue impairs health-related quality of life [6] and is associated with mortality [7][8][9]. Several complex clinical factors, some of which may be modifiable, correlate with fatigue in patients with CKD-D, including higher burden of medical comorbidities, sedentary lifestyle, obesity, hypoalbuminemia, and use of sleeping medications [4,[8][9][10]. Fatigue can be easily measured using self-reported patient questionnaires, such as the 16-item Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR 16 ) scale [11][12][13], the Beck Depression Inventory-I (BDI-I) [13,14], or the 12-Item short form 12 health survey (SF-12) scale [15].…”

Section: Introductionmentioning

confidence: 99%

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Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

et al. 2019

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Background: Fatigue, although common and associated with outcomes in dialysis-dependent chronic kidney disease (CKD), has not been studied in nondialysis chronic kidney disease (CKD-ND) patients. Methods: In this longitudinal cohort of 266 outpatients with CKD-ND stages 2–5, we measured self-reported fatigue on 3 scales-Quick Inventory of Depression Symptomatology-Self Report (QIDS-SR₁₆), Beck Depression Inventory-I (BDI-I), and short form 12 health survey (SF-12) questionnaires and evaluated the prespecified composite of progression to dialysis initiation, death, or hospitalization after 12 months. Logistic and linear regression assessed characteristics associated with fatigue. Survival analysis measured associations of fatigue with outcomes. Results: Mean age was 64.4 ± 12.0 years, and mean estimated glomerular filtration rate (eGFR) was 31.6 ± 16.7 mL/min/1.73 m². Fatigue was common, with 69.2% reporting fatigue on QIDS-SR₁₆ and 77.7% on BDI-I. Unemployment, comorbidities, use of antidepressant medications, and lower hemoglobin correlated with fatigue. There were 126 outcome events. Participants that reported any versus no fatigue on QIDS-SR₁₆ were more likely to reach the composite, hazard ratio (HR) 1.70 (95% CI 1.11–2.59), which persisted after adjusting for demographics, comorbidities, substance abuse, hemoglobin, albumin, eGFR, and calcium-phosphorus product, HR 1.63 (1.05–2.55). Fatigue severity by the SF-12 was also associated with outcomes independent of demographics, comorbidities, and substance abuse, HR per unit increase 1.18 (1.03–1.35). No association was observed with fatigue on the BDI-I. Conclusion: Fatigue affected about 2/3 of CKD-ND patients and associated with unemployment, comorbidities, antidepressant medication use, and anemia. Fatigue measured by the QIDS-SR₁₆ and SF-12 independently predicted outcomes in CKD patients. Eliciting the presence of fatigue may be a clinically significant prognostic assessment in CKD patients.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

et al. 2019

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“…The nature of palliative care in advanced stages of CKD is confounded by the heterogeneity of the patient population, a substantial symptom burden (Almutary et al . ), the availability of dialysis as a care pathway and the option to cease dialysis (Murtagh et al . ).…”

Section: Introductionmentioning

confidence: 99%

Tracking patients with advanced kidney disease in the last 12 months of life

Bonner

Chambers

Healy

et al. 2018

Journal of Renal Care

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“…The participants’ physical and mental health summary scores did not differ between the intervention and standard care groups demonstrating neither a positive nor adverse impact of OPTIONS. The sensitivity of HRQoL measures in detecting the influence of OPTIONS may be inadequate when taking into account the considerable impact advanced kidney disease has on individual's quality of life (Almutary, Bonner, & Douglas, ; Pagels, Soderkvist, Medin, Hylander, & Heiwe, ). Nevertheless, this study suggests that OPTIONS does not result in any adverse impact on a person's HRQoL.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial testing a decision support intervention for older patients with advanced kidney disease

Brown

Gardner

Bonner

2019

Journal of Advanced Nursing

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Aim To evaluate the effectiveness of a decision support intervention (OPTIONS) in facilitating the older person with advanced kidney disease to make a treatment choice. Design Pragmatic randomized controlled trial. Methods People aged ≥70 years with advanced kidney disease (eGFR ≤20 ml/min/1.73m2) who had not made a decision about treatment options and who were not eligible for a kidney transplant were recruited between March 2015 and March 2016. Participants were randomly allocated to receive the OPTIONS (N = 16) or standard care (N = 21). OPTIONS is a 4‐week nurse‐delivered intervention. Primary outcomes were decision conflict and decision regret, the secondary outcomes were knowledge of risk and benefits of dialysis and health‐related quality of life. The usefulness of OPTIONS was also evaluated. Results There were no differences between the intervention and standard care groups at baseline. At T1, there were no significant differences in decision conflict and decision regret although the intervention group had lower decisional conflict at T2. The decision support intervention was able to significantly improve the participants’ knowledge score in the intervention group. There were no observable differences between groups for health‐related quality of life physical and mental health component summary scores. OPTIONS was helpful in preparing participants in making a treatment decision. Conclusion OPTIONS, a decision support intervention, increased a person's knowledge of the benefits and risks of dialysis and can be used to facilitate shared decision‐making with older adults with advanced stages of kidney disease. Impact Strategies to improve shared decision‐making between older people with advanced stages of kidney disease and their clinicians are crucial for patient autonomy in a population where this may not be common practice. The decision support intervention– OPTIONS demonstrated significant improvement in patient knowledge about different treatment pathways. OPTIONS provides a structured and evidence‐based approach to support shared decision‐making for this population. Trial Registration ACTRN 12614001090606 Registered 14/10/2014.

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Which Patients With Chronic Kidney Disease Have the Greatest Symptom Burden? A Comparative Study of Advanced CKD Stage and Dialysis Modality

Cited by 114 publications

References 22 publications

Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

Tracking patients with advanced kidney disease in the last 12 months of life

A randomized controlled trial testing a decision support intervention for older patients with advanced kidney disease

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