Symptom Burden before and after Dialysis Initiation in Older Patients
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 investi...
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| Veröffentlicht in: | Clinical journal of the American Society of Nephrology 2022-12, Vol.17 (12), p.1719-1729 |
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| creator | 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 |
| description | 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.
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
. 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.
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
, 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.
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. |
| doi_str_mv | 10.2215/CJN.09190822 |
| format | Article |
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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
. 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.
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
, 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.
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.</description><identifier>ISSN: 1555-9041</identifier><identifier>EISSN: 1555-905X</identifier><identifier>DOI: 10.2215/CJN.09190822</identifier><identifier>PMID: 36357126</identifier><language>eng</language><publisher>United States: American Society of Nephrology</publisher><subject>Aged ; Female ; Humans ; Kidney Failure, Chronic - therapy ; Male ; Original ; Prevalence ; Prospective Studies ; Renal Dialysis - adverse effects ; Renal Insufficiency</subject><ispartof>Clinical journal of the American Society of Nephrology, 2022-12, Vol.17 (12), p.1719-1729</ispartof><rights>Copyright © 2022 by the American Society of Nephrology.</rights><rights>Copyright © 2022 by the American Society of Nephrology 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c422t-9614dfccac2a646fa0bc7fcfbc0d727409119960e3eb0973ca35aa70dedc737f3</citedby><cites>FETCH-LOGICAL-c422t-9614dfccac2a646fa0bc7fcfbc0d727409119960e3eb0973ca35aa70dedc737f3</cites><orcidid>0000-0002-4967-0916 ; 0000-0002-2433-2494 ; 0000-0002-5482-2013 ; 0000-0001-8650-5795 ; 0000-0003-4883-9174 ; 0000-0001-9507-5301 ; 0000-0003-3017-2885 ; 0000-0002-5199-3925 ; 0000-0002-1248-081X ; 0000-0003-4739-349X ; 0000-0003-0444-8569 ; 0000-0002-9891-2109</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9718015/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9718015/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,551,724,777,781,882,27905,27906,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36357126$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:151393454$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>de Rooij, Esther N M</creatorcontrib><creatorcontrib>Meuleman, Yvette</creatorcontrib><creatorcontrib>de Fijter, Johan W</creatorcontrib><creatorcontrib>Jager, Kitty J</creatorcontrib><creatorcontrib>Chesnaye, Nicholas C</creatorcontrib><creatorcontrib>Evans, Marie</creatorcontrib><creatorcontrib>Caskey, Fergus J</creatorcontrib><creatorcontrib>Torino, Claudia</creatorcontrib><creatorcontrib>Porto, Gaetana</creatorcontrib><creatorcontrib>Szymczak, Maciej</creatorcontrib><creatorcontrib>Drechsler, Christiane</creatorcontrib><creatorcontrib>Wanner, Christoph</creatorcontrib><creatorcontrib>Dekker, Friedo W</creatorcontrib><creatorcontrib>Hoogeveen, Ellen K</creatorcontrib><creatorcontrib>EQUAL study investigators</creatorcontrib><title>Symptom Burden before and after Dialysis Initiation in Older Patients</title><title>Clinical journal of the American Society of Nephrology</title><addtitle>Clin J Am Soc Nephrol</addtitle><description>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.
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
. 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.
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
, 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.
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.</description><subject>Aged</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Male</subject><subject>Original</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Renal Dialysis - adverse effects</subject><subject>Renal Insufficiency</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>D8T</sourceid><recordid>eNpVkUtPAyEUhYnR2FrduTazdOFUnkPZmGitWtNYEzVxRxgGFJ1Hhamm_15MH7ErLpzvHu7NAeAYwT7GiJ0P7x_6UCABBxjvgC5ijKUCstfdTU1RBxyE8AEhpQSzfdAhGWEc4awLRk-LatY2VXI194Wpk9zYxptE1UWibGt8cu1UuQguJOPatU61rqkTVyfTsojiY7ybug2HYM-qMpij1dkDLzej5-FdOpnejoeXk1RTjNtUZIgWVmulscpoZhXMNbfa5hoWHHMa10BCZNAQk0PBiVaEKcVhYQrNCbekB9Klb_gxs3kuZ95Vyi9ko5xcPX3GykhKRcYHkb9Y8lGpokmc1atyq21bqd27fGu-peBoABGLBqcrA998zU1oZeWCNmWpatPMg8ScsAGHDKGIni1R7ZsQvLGbbxCUf0nJmJRcJxXxk_-jbeB1NOQXP1-Qbg</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>de Rooij, Esther N M</creator><creator>Meuleman, Yvette</creator><creator>de Fijter, Johan W</creator><creator>Jager, Kitty J</creator><creator>Chesnaye, Nicholas C</creator><creator>Evans, Marie</creator><creator>Caskey, Fergus J</creator><creator>Torino, Claudia</creator><creator>Porto, Gaetana</creator><creator>Szymczak, Maciej</creator><creator>Drechsler, Christiane</creator><creator>Wanner, Christoph</creator><creator>Dekker, Friedo W</creator><creator>Hoogeveen, Ellen K</creator><general>American Society of Nephrology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-4967-0916</orcidid><orcidid>https://orcid.org/0000-0002-2433-2494</orcidid><orcidid>https://orcid.org/0000-0002-5482-2013</orcidid><orcidid>https://orcid.org/0000-0001-8650-5795</orcidid><orcidid>https://orcid.org/0000-0003-4883-9174</orcidid><orcidid>https://orcid.org/0000-0001-9507-5301</orcidid><orcidid>https://orcid.org/0000-0003-3017-2885</orcidid><orcidid>https://orcid.org/0000-0002-5199-3925</orcidid><orcidid>https://orcid.org/0000-0002-1248-081X</orcidid><orcidid>https://orcid.org/0000-0003-4739-349X</orcidid><orcidid>https://orcid.org/0000-0003-0444-8569</orcidid><orcidid>https://orcid.org/0000-0002-9891-2109</orcidid></search><sort><creationdate>20221201</creationdate><title>Symptom Burden before and after Dialysis Initiation in Older Patients</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-9614dfccac2a646fa0bc7fcfbc0d727409119960e3eb0973ca35aa70dedc737f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Male</topic><topic>Original</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Renal Dialysis - adverse effects</topic><topic>Renal Insufficiency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>de Rooij, Esther N M</creatorcontrib><creatorcontrib>Meuleman, Yvette</creatorcontrib><creatorcontrib>de Fijter, Johan W</creatorcontrib><creatorcontrib>Jager, Kitty J</creatorcontrib><creatorcontrib>Chesnaye, Nicholas C</creatorcontrib><creatorcontrib>Evans, Marie</creatorcontrib><creatorcontrib>Caskey, Fergus J</creatorcontrib><creatorcontrib>Torino, Claudia</creatorcontrib><creatorcontrib>Porto, Gaetana</creatorcontrib><creatorcontrib>Szymczak, Maciej</creatorcontrib><creatorcontrib>Drechsler, Christiane</creatorcontrib><creatorcontrib>Wanner, Christoph</creatorcontrib><creatorcontrib>Dekker, Friedo W</creatorcontrib><creatorcontrib>Hoogeveen, Ellen K</creatorcontrib><creatorcontrib>EQUAL study investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Clinical journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>de Rooij, Esther N M</au><au>Meuleman, Yvette</au><au>de Fijter, Johan W</au><au>Jager, Kitty J</au><au>Chesnaye, Nicholas C</au><au>Evans, Marie</au><au>Caskey, Fergus J</au><au>Torino, Claudia</au><au>Porto, Gaetana</au><au>Szymczak, Maciej</au><au>Drechsler, Christiane</au><au>Wanner, Christoph</au><au>Dekker, Friedo W</au><au>Hoogeveen, Ellen K</au><aucorp>EQUAL study investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Symptom Burden before and after Dialysis Initiation in Older Patients</atitle><jtitle>Clinical journal of the American Society of Nephrology</jtitle><addtitle>Clin J Am Soc Nephrol</addtitle><date>2022-12-01</date><risdate>2022</risdate><volume>17</volume><issue>12</issue><spage>1719</spage><epage>1729</epage><pages>1719-1729</pages><issn>1555-9041</issn><eissn>1555-905X</eissn><abstract>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.
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
. 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.
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
, 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.
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.</abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>36357126</pmid><doi>10.2215/CJN.09190822</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-4967-0916</orcidid><orcidid>https://orcid.org/0000-0002-2433-2494</orcidid><orcidid>https://orcid.org/0000-0002-5482-2013</orcidid><orcidid>https://orcid.org/0000-0001-8650-5795</orcidid><orcidid>https://orcid.org/0000-0003-4883-9174</orcidid><orcidid>https://orcid.org/0000-0001-9507-5301</orcidid><orcidid>https://orcid.org/0000-0003-3017-2885</orcidid><orcidid>https://orcid.org/0000-0002-5199-3925</orcidid><orcidid>https://orcid.org/0000-0002-1248-081X</orcidid><orcidid>https://orcid.org/0000-0003-4739-349X</orcidid><orcidid>https://orcid.org/0000-0003-0444-8569</orcidid><orcidid>https://orcid.org/0000-0002-9891-2109</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; SWEPUB Freely available online; PubMed Central; Alma/SFX Local Collection |
| subjects | Aged Female Humans Kidney Failure, Chronic - therapy Male Original Prevalence Prospective Studies Renal Dialysis - adverse effects Renal Insufficiency |
| title | Symptom Burden before and after Dialysis Initiation in Older Patients |
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