Symptom Burden before and after Dialysis Initiation in Older Patients. Issue 12 (December 2022)

• Record Type: Journal Article
• Authors: de Rooij, Esther N.M.; Meuleman, Yvette; de Fijter, Johan W.; Jager, Kitty J.; Chesnaye, Nicholas C.; Evans, Marie; Caskey, Fergus J.; Torino, Claudia; Porto, Gaetana; Szymczak, Maciej; Drechsler, Christiane; Wanner, Christoph; Dekker, Friedo W.; Hoogeveen, Ellen K.
• Other Names: author non-byline.; Schneider Andreas author non-byline.; Torp Anke author non-byline.; Iwig Beate author non-byline.; Perras Boris author non-byline.; Marx Christian author non-byline.; Drechsler Christiane author non-byline.; Blaser Christof author non-byline.; Wanner Christoph author non-byline.; Emde Claudia author non-byline.; Krieter Detlef author non-byline.; Fuchs Dunja author non-byline.; Irmler Ellen author non-byline.; Platen Eva author non-byline.; Schmidt-Gürtler Hans author non-byline.; Schlee Hendrik author non-byline.; Naujoks Holger author non-byline.; Schlee Ines author non-byline.; Cäsar Sabine author non-byline.; Beige Joachim author non-byline.; Röthele Jochen author non-byline.; Mazur Justyna author non-byline.; Hahn Kai author non-byline.; Blouin Katja author non-byline.; Neumeier Katrin author non-byline.; Anding-Rost Kirsten author non-byline.; Schramm Lothar author non-byline.; Hopf Monika author non-byline.; Wuttke Nadja author non-byline.; Frischmuth Nikolaus author non-byline.; Ichtiaris Pawlos author non-byline.; Kirste Petra author non-byline.; Schulz Petra author non-byline.; Aign Sabine author non-byline.; Biribauer Sandra author non-byline.; Manan Sherin author non-byline.; Röser Silke author non-byline.; Heidenreich Stefan author non-byline.; Palm Stephanie author non-byline.; Schwedler Susanne author non-byline.; Delrieux Sylke author non-byline.; Renker Sylvia author non-byline.; Schättel Sylvia author non-byline.; Stephan Theresa author non-byline.; Schmiedeke Thomas author non-byline.; Weinreich Thomas author non-byline.; Leimbach Til author non-byline.; Stövesand Torsten author non-byline.; Bahner Udo author non-byline.; Seeger Wolfgang author non-byline.; Cupisti Adamasco author non-byline.; Sagliocca Adelia author non-byline.; Ferraro Alberto author non-byline.; Mele Alessandra author non-byline.; Naticchia Alessandro author non-byline.; Còsaro Alex author non-byline.; Ranghino Andrea author non-byline.; Stucchi Andrea author non-byline.; Pignataro Angelo author non-byline.; 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Acampora Pina author non-byline.; Nigro Rita author non-byline.; Boero Roberto author non-byline.; Scarpioni Roberto author non-byline.; Sicoli Rosa author non-byline.; Malandra Rosella author non-byline.; Savoldi Silvana author non-byline.; Bertoli Silvio author non-byline.; Borrelli Silvio author non-byline.; Maxia Stefania author non-byline.; Maffei Stefano author non-byline.; Mangano Stefano author non-byline.; Cicchetti Teresa author non-byline.; Rappa Tiziana author non-byline.; Palazzo Valentina author non-byline.; De Simone Walter author non-byline.; Schrander Anita author non-byline.; van Dam Bastiaan author non-byline.; Siegert Carl author non-byline.; Gaillard Carlo author non-byline.; Beerenhout Charles author non-byline.; Verburgh Cornelis author non-byline.; Janmaat Cynthia author non-byline.; Hoogeveen Ellen author non-byline.; Hoorn Ewout author non-byline.; Dekker Friedo author non-byline.; Boots Johannes author non-byline.; Boom Henk author non-byline.; Eijgenraam Jan-Willem author non-byline.; 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Durlik Magdalena author non-byline.; Dorota Szyszkowska author non-byline.; Nieszporek Teresa author non-byline.; Heleniak Zbigniew author non-byline.; Jonsson Andreas author non-byline.; Blom Anna-Lena author non-byline.; Rogland Björn author non-byline.; Wallquist Carin author non-byline.; Vargas Denes author non-byline.; Dimény Emöke author non-byline.; Sundelin Fredrik author non-byline.; Uhlin Fredrik author non-byline.; Welander Gunilla author non-byline.; Hernandez Isabel Bascaran author non-byline.; Gröntoft Knut-Christian author non-byline.; Stendahl Maria author non-byline.; Svensson Maria author non-byline.; Evans Marie author non-byline.; Heimburger Olof author non-byline.; Kashioulis Pavlos author non-byline.; Melander Stefan author non-byline.; Almquist Tora author non-byline.; Jensen Ulrika author non-byline.; Woodman Alistair author non-byline.; McKeever Anna author non-byline.; Ullah Asad author non-byline.; McLaren Barbara author non-byline.; Harron Camille author non-byline.; Barrett Carla author non-byline.; O'Toole Charlotte author non-byline.; Summersgill Christina author non-byline.; Geddes Colin author non-byline.; Glowski Deborah author non-byline.; McGlynn Deborah author non-byline.; Sands Dympna author non-byline.; Caskey Fergus author non-byline.; Roy Geena author non-byline.; Hirst Gillian author non-byline.; King Hayley author non-byline.; McNally Helen author non-byline.; Masri-Senghor Houda author non-byline.; Murtagh Hugh author non-byline.; Rayner Hugh author non-byline.; Turner Jane author non-byline.; Wilcox Joanne author non-byline.; Berdeprado Jocelyn author non-byline.; Wong Jonathan author non-byline.; Banda Joyce author non-byline.; Jones Kirsteen author non-byline.; Haydock Lesley author non-byline.; Wilkinson Lily author non-byline.; Carmody Margaret author non-byline.; Weetman Maria author non-byline.; Joinson Martin author non-byline.; Dutton Mary author non-byline.; Matthews Michael author non-byline.; Morgan Neal author non-byline.; Bleakley Nina author non-byline.; Cockwell Paul author non-byline.; Roderick Paul author non-byline.; Mason Phil author non-byline.; Kalra Philip author non-byline.; Sajith Rincy author non-byline.; Chapman Sally author non-byline.; Navjee Santee author non-byline.; Crosbie Sarah author non-byline.; Brown Sharon author non-byline.; Tickle Sheila author non-byline.; Mathavakkannan Suresh author non-byline.; Kuan Ying author non-byline.;
• Is Part Of: Clinical journal of the American Society of Nephrology. Volume 17:Issue 12(2022)
• Page Start: 1719
• Page End: 1729
• Publication Date: 2022-12
• Subjects: dialysis -- end stage kidney disease -- epidemiology and outcomes -- elderly -- chronic kidney disease
• DOI: 10.2215/CJN.09190822
• Languages: English
• ISSNs: 1555-9041

Abstract

Visual Abstract: Abstract : Background and objectives: For older patients with kidney failure, lowering symptom burden may be more important than prolonging life. Dialysis initiation may affect individual kidney failure–related symptoms differently, but the change in symptoms before and after start of dialysis has not been studied. Therefore, we investigated the course of total and individual symptom number and burden before and after starting dialysis in older patients. Design, setting, participants, & measurements: The European Quality (EQUAL) study is an ongoing, prospective, multicenter study in patients ≥65 years with an incident eGFR ≤20 ml/min per 1.73 m 2 . Using the dialysis symptom index (DSI), 30 symptoms were assessed every 3–6 months between 2012 and 2021. Scores for symptom number range from zero to 30 and, for burden, from zero to 150, with higher scores indicating more severity. Using mixed effects models, we studied symptoms during the year preceding and the year after dialysis initiation. Results: We included 456 incident patients on dialysis who filled out at least one DSI during the year before or after dialysis. At dialysis initiation, mean (SD) participant age was 76 (6) years, 75% were men, mean (SD) eGFR was 8 (3) ml/min per 1.73 m 2, 44% had diabetes, and 46% had cardiovascular disease. In the year before dialysis initiation, symptom number increased +3.6 (95% confidence interval [95% CI], +2.5 to +4.6) and symptom burden increased +13.3 (95% CI, +9.5 to +17.0). In the year after, symptom number changed −0.9 (95% CI, −3.4 to +1.5) and burden decreased −5.9 (95% CI, −14.9 to −3.0). At dialysis initiation, "fatigue, " "decreased interest in sex, " and "difficulty becoming sexually aroused" had the highest prevalence of 81%, 69%, and 68%, respectively, with a burden of 2.7, 2.4, and 2.3, respectively. "Fatigue" somewhat improved after dialysis initiation, whereas the prevalence and burden of sexual symptoms further increased. Conclusions: Symptom burden worsened considerably before and stabilized after dialysis initiation. "Fatigue, " "decreased interest in sex, " and "difficulty becoming sexually aroused" were considered most burdensome, of which only "fatigue" somewhat improved after dialysis initiation.