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Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study.

ABSTRACT: People with end stage renal disease and undergoing hemodialysis experience a high symptom burden that impairs quality of life. This study aimed to assess the prevalence, dynamicity and determinants of symptom burden among middle-aged and older adult hemodialysis patients. A descriptive cross-sectional study together with a longitudinal assessment was used. A total of 118 and 102 hemodialysis patients were assessed at baseline and at a 6-month follow-up. Validated questionnaires were used to assess the symptom burden, stress, illness perception and social support. Multiple linear regression analysis was used to determine the factors associated with symptom burden. The median number of symptoms experienced was 21 (Interquartile Range (IQR); 18-23) and 19 (IQR; 13-22) at baseline and 6 months, respectively. Having elevated stress (β = 0.65, p ≤ 0.005) and illness perception (β = 0.21, p = 0.02) were significantly predicted symptom burden at baseline (F (4, 112) = 55.29, p < 0.005, R² = 0.664). Stress (β = 0.28, p = 0.003), illness perception (β = 0.2, p = 0.03), poor social support (β = -0.22, p = 0.01) and low body weight (β = -0.19, p = 0.03) were the determinants for symptom burden at 6 months (F (5, 93) = 4.85, p ≤ 0.005, R² = 0.24). Elevated stress, illness perception level, poor social support and low post-dialysis body weight were found to be determinants for symptom burden. Attention should be given to psychosocial factors of hemodialysis patients while conducting assessment and delivering care to patients.

SUBMITTER: Gunarathne TGNS

PROVIDER: S-EPMC9105408 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study.

Gunarathne Thalwaththe Gedara Nadeeka Shayamalie TGNS Tang Li Yoong LY Lim Soo Kun SK Nanayakkara Nishantha N Damayanthi Hewaratne Dassanayakege Wimala Thushari HDWT Abdullah Khatijah L KL

International journal of environmental research and public health 20220503 9

People with end stage renal disease and undergoing hemodialysis experience a high symptom burden that impairs quality of life. This study aimed to assess the prevalence, dynamicity and determinants of symptom burden among middle-aged and older adult hemodialysis patients. A descriptive cross-sectional study together with a longitudinal assessment was used. A total of 118 and 102 hemodialysis patients were assessed at baseline and at a 6-month follow-up. Validated questionnaires were used to asse ...[more]

PMID: 35564935

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Project description:ObjectivesTo compare the mortality of elderly adults with end-stage renal disease (ESRD) treated with home hemodialysis (HD) with that of those receiving a kidney transplant (KTx).DesignProspective cohort.SettingPertinent data for the two groups were obtained from electronic medical records from a large dialysis provider and the U.S. Renal Data System.ParticipantsUsing data from elderly adults (aged ≥65) who started home HD and underwent KTx in the US between 2007 and 2011, a 1:1 propensity score (PS)-matched cohort of 960 elderly adults was created, and the association between treatment modality and all-cause mortality was examined using Cox proportional hazards and competing risk regression survival models using modality failure as a competing event.MeasurementsModality of renal replacement therapy.ResultsThe baseline mean age ± standard deviation of the PS-matched individuals undergoing home HD was 71 ± 6, and that of KTx recipients was 71 ± 5, 69% of both groups were male, 81% of those undergoing home HD and 79% of KTx recipients were white, and 11% and 12%, respectively, were African American. Median follow-up time was 205 days (interquartile range (IQR) 78-364 days) for those undergoing home HD and 795 days (IQR 366-1,221 days) for KTx recipients. There were 97 deaths (20%, 253/1,000 patient-years, 95% confidence interval (CI) = 207-309/1,000 patient-years) in the home HD group and 48 deaths (10%, 45/1,000 patient-years, 95% CI = 34-60/1,000 patient-years) in the KTx group. Elderly adults undergoing home HD had a risk of mortality that was almost five times as high as that of KTx recipients (hazard ratio = 4.74, 95% CI = 3.25-6.91). Similar results were seen in competing risk regression analyses (subhazard ratio = 4.71, 95% CI = 3.27-6.79). Results were consistent across different types of kidney donors and subgroups divided according to various recipient characteristics.ConclusionElderly adults with ESRD who receive a KTx have greater survival than those who undergo home HD. Further studies are needed to assess whether KTx receipt is associated with other benefits such as better quality of life and lower hospitalization rates.

Project description:BackgroundThe effects of end-stage kidney disease (ESKD) can spill over into a patient's social life. Social capital (SC) is a determinant of health that can enhance patients' health through support and resources. However, no questionnaire is currently available to measure SC in ESKD patients. This study aimed to design and validate a questionnaire to measure SC in ESKD adults undergoing dialysis or hemodialysis.MethodsA mixed methods approach was used to generate the questionnaire and determine its content validity with a panel of nine experts and content validity index, face validity through cognitive interviews with patients, construct validity (exploratory and confirmatory factor analysis), criterion validity, reliability and the effect of known groups differences.ResultsContent validity was confirmed by an expert panel, achieving a content validity index value > 0.85 for all items. Face validity was achieved through cognitive interviews with 20 patients over 18 years of age in a terminal stage of CKD, ensuring that the target population understood the questions. An exploratory factor analysis used the sample of 610 patients and tested the structure of the seven dimensions of the structural domain (participation in organizations, links to institutions, social network sizes, collective activities, diversity, bridging, and bonding) and explained 95.7% of the total variance with a reliability of 0.89, and criterion validity > 0.32 (p < 0.05) for the correlations between the indices of each dimension and the domain index. The structure of the cognitive domain was tested for six dimensions (norms of reciprocity, social harmony, feeling of belonging, perceived fairness, social support, and social trust) with a total variance of 80.7%, reliability of 0.94 and criterion validity for correlations > 0.68 (p < 0.05). The confirmatory factor analysis with 352 patients proved the factorial structure adequate for both questionnaire domains and all dimensions, with CFI and TLI values > 0.9, an RMSEA ≤ 0.06, and SRMR ≤ 0.05.ConclusionsWe conclude that the questionnaire designed to measure social capital is valid and reliable for ESKD patients in Mexico.

Project description:ContextPrevious studies on quality of life (QOL) after lung cancer surgery have identified a long duration of symptoms postoperatively. We first performed a systematic review of QOL in patients undergoing surgery for lung cancer. A subgroup analysis was conducted focusing on symptom burden and its relationship with QOL.ObjectiveTo perform a qualitative review of articles addressing symptom burden in patients undergoing surgical resection for lung cancer.MethodsThe parent systematic review utilized search terms for symptoms, functional status, and well-being as well as instruments commonly used to evaluate global QOL and symptom experiences after lung cancer surgery. The articles examining symptom burden (n = 54) were analyzed through thematic analysis of their findings and graded according to the Oxford Centre for Evidence-based Medicine rating scale.ResultsThe publication rate of studies assessing symptom burden in patients undergoing surgery for lung cancer have increased over time. The level of evidence quality was 2 or 3 for 14 articles (cohort study or case control) and level of 4 in the remaining 40 articles (case series). The most common QOL instruments used were the Short Form 36 and 12, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, and the Hospital Anxiety and Depression Score. Thematic analysis revealed several key findings: 1) lung cancer surgery patients have a high symptom burden both before and after surgery; 2) pain, dyspnea, cough, fatigue, depression, and anxiety are the most commonly studied symptoms; 3) the presence of symptoms prior to surgery is an important risk factor for higher acuity of symptoms and persistence after surgery; and 4) symptom burden is a predictor of postoperative QOL.ConclusionLung cancer patients undergoing surgery carry a high symptom burden which impacts their QOL. Measurement approaches use myriad and heterogenous instruments. More research is needed to standardize symptom burden measurement and management, with the goal to improve patient experience and overall outcomes.

Dataset Information

Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study.

Publications

Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study.

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