Exploration of symptom clusters and their trajectories in maintenance hemodialysis patients

To investigate symptom clusters and their longitudinal trajectories in patients undergoing maintenance hemodialysis (MHD).

A convenience sample of 510 MHD patients was enrolled between June 2022 and June 2023. Symptom assessments were conducted at four time points: baseline (T1), 4 months (T2), 8 months (T3), and 12 months (T4), using a general information questionnaire and the dialysis symptom index (DSI). Exploratory factor analysis was applied to identify symptom clusters, and latent class growth modeling was used to examine the longitudinal trajectories of these symptom clusters over the one-year follow-up period.

Exploratory factor analysis revealed seven symptom clusters: emotional symptoms, water-electrolyte imbalances, gastrointestinal symptoms, uremia-related symptoms, sleep disturbances, sexual symptoms, and sexual-emotional symptoms. The first five clusters-emotional, water-electrolyte imbalances, gastrointestinal, uremia-related, and sleep disturbances-exhibited common patterns over time. Latent class growth models identified 3 distinct trajectories within each symptom cluster, reflecting heterogeneous patterns of symptom progression.

This one-year longitudinal study revealed heterogeneous developmental trajectories across symptom clusters in MHD patients. These findings underscore the importance of continuous symptom assessment and monitoring, particularly in patients with persistently high symptom severity. Tailored intervention strategies should be developed to address the specific needs of different patient subgroups, thereby alleviating symptom burden and enhancing the effectiveness of nursing care. Symptom management efforts may be prioritized based on the severity and trajectory of symptom clusters.