Abstract: FR-PO420
Exploring the Skin Symptom Cluster in a Prevalent Hemodialysis (HD) Cohort: The Dominance of CKD-Associated Pruritus and the Association with Fatigue
Session Information
- Hemodialysis: Quality of Life, Symptoms, Palliative Care
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Hull, Katherine Leigh, University of Leicester College of Life Sciences, Leicester, United Kingdom
- Joshi, Namrata, University of Leicester College of Life Sciences, Leicester, United Kingdom
- Jennings, Angus C., University of Leicester College of Life Sciences, Leicester, United Kingdom
- Billany, Roseanne, University of Leicester College of Life Sciences, Leicester, United Kingdom
- March, Daniel Scott, University of Leicester College of Life Sciences, Leicester, United Kingdom
- Graham-Brown, Matthew, University of Leicester College of Life Sciences, Leicester, United Kingdom
- Burton, James, University of Leicester College of Life Sciences, Leicester, United Kingdom
Background
Haemodialysis (HD) patients have a high symptom burden. Dominant symptoms may precipitate or intensify others, generating a symptom cluster: the co-existence of ≥2 symptoms. This work explores the skin symptom cluster (itching, restless legs, skin changes, difficulty in sleeping) in prevalent HD patients.
Methods
We present prospective symptom data (POS-S Renal) from the CYCLE-HD trial (ISRCTN11299707). Spearman’s rank correlations were considered, alongside linear regression (cluster sum score) and proportional odds logistic regression (fatigue sub-score), both adjusted for age, sex, dialysis vintage and BMI.
Results
118 participants provided symptom data. 77 (65.3%) participants reported ≥2 skin cluster symptoms at baseline. There were positive correlations between each symptom in the skin cluster (all coefficients ≥0.36). A one point difference in baseline itch was associated with a 0.87 increase in total skin cluster score at 6-months; these data, as well as relationships with other symptoms in the cluster, are outlined in Table 1. 70 (59.3%) participants reported fatigue alongside ≥2 skin cluster symptoms at baseline. A unit increase in the skin cluster score at baseline was associated with a 16.1% (3.6-30.1%) higher odds of one unit increase in fatigue at 6-months.
Conclusion
Reporting of symptoms from within the skin cluster is common in the HD population. CKD-aP is the predominant symptom in predicting the persistence and exacerbation of the skin cluster. The skin symptom cluster and fatigue often co-exist and are interdependent. This highlights the importance of elucidating symptom clusters in routine care to improve management of intrusive symptoms.
6-month skin symptom cluster score normal linear model
| Parameter | Estimate | 95% CI | P-value |
| Intercept | 1.36 | (-2.29,5.01) | 0.4602 |
| BL Itching | 0.87 | (0.36,1.39) | 0.0011 |
| BL Difficulty Sleeping | 0.66 | (0.19,1.14) | 0.0066 |
| BL Restless Legs | 0.65 | (0.17,1.12) | 0.0082 |
| BL Changes in Skin | 0.43 | (-0.15,1.01) | 0.141 |
| Group (ref=Control) | -0.07 | (-1.1,0.95) | 0.8875 |
| Age | - | - | 0.6824 |
| Gender (ref=Female) | 0.69 | (-0.45,1.83) | 0.2307 |
| Dialysis Vintage | -0.03 | (-0.23,0.18) | 0.7853 |
| BMI | -0.06 | (-0.15,0.03) | 0.1671 |
Funding
- Other NIH Support