Impact of renal supportive care on symptom burden in dialysis patients: a prospective observational cohort study.
Abstract
CONTEXT
Symptom burden is a strong predictor of reduced health-related quality of life and survival in patients with end-stage kidney disease (ESKD). Renal supportive care (RSC) is a comprehensive approach shown to benefit symptoms in non-dialysis conservatively managed patients, though its role in dialysis patients has not been reported.
OBJECTIVES
This study aimed to investigate the impacts of RSC intervention on symptoms in dialysis patients.
METHODS
Dialysis patients referred to a RSC clinic for symptom control between April 2010 and December 2017 were followed prospectively. Symptoms were scored using the IPOS-Renal inventory. Change in symptoms was analyzed at 3 visits and at final RSC visit within the study period. Correlation and linear regression were used to assess for effect modifiers.
RESULTS
127 dialysis patients attended the RSC clinic for symptom management. Median age was 74 years, 62% male, median dialysis vintage 2.2 years and median modified Charlson comorbidity index 7. Mean combined physical and emotional symptom score at baseline was 17.5 (SD 9.6), the most overwhelming/severe symptoms being difficulty sleeping (35%), pain (31%), lack of energy (31%), poor mobility (24%) and itch (22%). 80 patients had follow-up to at least 3 RSC visits (median 3.1 months). There was significant improvement in combined physical and emotional symptom score over 3 clinic visits (18.1 vs. 14.2, mean change -3.8, 95% CI -5.7 to -1.9, p<0.001), with greatest improvement in…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 127 participants or records.
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