Kidney Week

Abstract: PUB144

Fatigue Has the Highest Diurnal Symptom Variability in Patients on Dialysis

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Ozturk, Elife, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, Netherlands

Elife Ozturk, MD

• Smith, Aidan Willem, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, Netherlands

Aidan Willem Smith

• Noelmans, Jessica, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, Netherlands

Jessica Noelmans

• Spruit, Martijn A., Ciro-Horn, Horn, Netherlands

Martijn A. Spruit, MSc, PhD, MBA

• Kooman, Jeroen, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, Netherlands

Jeroen Kooman, MD, PhD

• Hemmelder, Marc H., Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, Netherlands

Marc H. Hemmelder, MD, PhD

Background

Patients treated with dialysis (hemodialysis (HD) and peritoneal dialysis (PD) have a high burden of disease. The amount of and the burden of symptoms experienced by dialysis patients is often underestimated. Limited data are available regarding the diurnal variability of symptoms. We therefore analyzed the diurnal variability of symptoms in HD and PD patients.

Methods

This prospective study was performed as a single center study. Patients completed baseline questionnaires on quality of life (SF-12), symptom burden (DSI), anxiety and depression (HADS), general level of daytime sleepiness and patient activation measurement(self-efficacy). After installing of a mobile application (Your Research®) on the patients’ smartphone, patients received 8 times a day during 7 consecutive days a questionnaire on symptom burden. Symptoms were scored on a scale from 1 (no symptoms) to 7 (most severe intensity). The diurnal variability of 4 frequently occurring symptoms (fatigue, anxiety, muscle soreness and headache) was assessed with the with-in subject standard deviation (WS-SD). In case of HD, WS-SDw was also calculated on HD days and non-HD days.

Results

25 dialysis patients were included (15 HD and 10 PD). Ten patients answered <50% of the questionnaires by mobile app and were excluded from the analyses. The remaining 15 patients (53% male, age 59 years) had an overall median symptom score of 4 for fatigue and 1 for anxiety, muscle soreness and headache. Median fatigue scores were not different between HD days versus non-HD days or between both dialysis modalities. Median WS-SD for fatigue was 1,01 (IQR 0,34). Median WS-SD was 0 for anxiety (IQR 0,44), 0,44 for muscle soreness (IQR:0,83) and 0,32 for headache (IQR: 0,50).

Conclusion

Fatigue is clearly the most intense symptom for HD and PD patients compared to anxiety, muscle soreness and headache. Fatigue does not exacerbate on HD versus non-HD days in HD patients. The expected symptom variability within and between days seems lower than expected. This may suggest that a simple spot check of symptom burden may sufficient to understand the symptoms throughout the day.