Decoding hemodialysis patients' symptoms: navigating the complexity

Hemodialysis (HD) patients frequently experience symptoms that negatively impact their quality of life. Besides individual symptoms, cluster symptoms and core symptoms are similarly important. Identifying these symptoms helps optimize patient care. This study was conducted to assess the various symptoms experienced by HD patients, their associated dimensions, factors, connections, and relationships.

A cross-sectional study of 1156 patients undergoing HD in 27 centers across different regions in Egypt. Patients were approached through face-to-face interviews and patients' medical records were reviewd. Comorbidities were evaluated using a revised edition of the Charlson Comorbidity Index. The validated Arabic version of the Chronic Kidney Disease Symptom Burden Index (CKD-SBI) was applied to assess symptom burden. Network and principal component analyses were employed to identify core and cluster symptoms, respectively. Independent predictors of higher symptom burden were identified using logistic regression.

The median age of patients was 53 years. HD patients experienced an average of 9 symptoms with a median total symptom burden score of 14.01. Bone/joint pain was the most common individual symptom (62.9%), followed by feeling tired or lack of energy (57.4%), and muscle cramps (49.6%). Seven symptom clusters were identified. Feeling nervous and worrying were the core symptoms in the symptom network. Sex, residence, prior kidney transplantation, non-use of calcium channel blockers, functional status, Charlson Comorbidity Index, and hemoglobin level were independent predictors of symptom burden.

Symptom burden among HD patients is complex, and rigorous measures are warranted to relieve these symptoms and improve patients' well-being.