Symptom Clusters in Local End-stage Renal Disease Patients Undergoing Dialysis

Introduction:

End-stage renal disease (ESRD) describes a condition in which the decline of renal function becomes critical and irreversible. This deterioration in renal function affects various organ systems. In addition to the side effects of dialysis therapy, ESRD patients report a high number of co-occurring symptoms. These symptoms result in a high symptom burden. Increased knowledge of how symptoms cluster may assist renal nurses to formulate strategies to manage multiple symptoms. However, existing evidence on symptom clusters in patients with ESRD is limited.

Objective:

To identify symptom clusters in Hong Kong ESRD patients undergoing dialysis.

Methodology:

This study employed a cross-sectional quantitative design. Eligible participants: 1) had a diagnosis of ESRD; 2) had received dialysis for minimum three months; and 3) gave an informed consent. The occurrence and distress of symptoms were measured by Dialysis Symptom Index Traditional Chinese Version. Symptom clusters were identified using exploratory factor analysis (EFA).

Results:

A total of 354 patients were recruited at the two study sites. The majority of patients was male (58.5%) with a mean age of 60.9 years. More than 70% received peritoneal dialysis. Patients reported a mean of 12.0 concurrent symptoms (SD = 5.86). The most prevalent symptoms were itching (78.0%), dry skin (76.0%), and feeling tired or lack of energy (73.7%). The most bothersome symptoms were trouble falling asleep (M = 3.59, SD = 1.16), trouble staying asleep (M = 3.34, SD = 1.17), and itching (M = 3.30, SD = 1.22). The EFA identified four clusters: 1) uraemic (constipation, numbness or tingling in feet, feeling tired or lack of energy, bone/joint pain, and muscle soreness); 2) gastrointestinal (nausea, vomiting, decreased appetite, and cough); 3) skin (dry skin, itching, trouble falling and staying asleep); and 4) emotional (difficulty concentrating, worrying, feeling nervous, irritable, sad, and anxious).

Conclusions:

Multiple concurrent symptoms are common and bothersome in ESRD patients. These symptoms shared inter-correlations and formed clusters. Therefore, renal nurses may focus their care to alleviate these symptom clusters. Future studies can explore the relationships between the clustered symptoms and their impact on outcomes.