Symptom Burden in Patients on Peritoneal Dialysis

Kidney supportive care (KSC) is a standard of care in Australia for patients with advanced kidney failure where health systems work to help manage the high burden of patients’ physical and psychosocial symptoms. According to Holly Brand and colleagues, while there have been studies examining the symptom burden among patients on hemodialysis, there are few data available on the symptom burden among patients on peritoneal dialysis.

The researchers conducted a study to describe the symptom burden experienced by patients on peritoneal dialysis and by patients on hemodialysis seen in a KSC clinic. Results were reported at the ERA 60th Congress in a presentation titled Kidney Supportive Care for Patients on Peritoneal Dialysis: Are Symptoms Being Addresses? A Retrospective Study.

The researchers analyzed data on patients who attended a multisite KSC clinic in Brisbane, Australia, between February 2016 and October 2022. Clinical records were used to extract patient demographic characteristics, dialysis modality, Charlson Comorbidity (CCI) scores, and Integrated Palliative Care Outcome Scale Renal (IPOS-Renal) scores. Intraperson physical symptom burden, determined by IPOS-Renal physical scores at baseline, was compared with the scores at a subsequent clinic visit where applicable. Descriptive and group analyses were performed.

The cohort included 232 participants. Of those, 201 were on hemodialysis and 31 were on peritoneal dialysis. Median age was 689 years, 57.3% were male, and 55.2% were referred to KSC primarily for symptom management. The two groups were similar in demographic characteristics and reasons for referral to KSC. Initial entry to the KSC clinic was considered baseline.

At baseline, median CCI was 9  and mean total IOPS score was 16.59. The groups were similar in symptom prevalence. Weakness was the most prevalent symptom (76.0%), followed by poor mobility (74.2%), pain (60.9%), drowsiness (55.8%), and dyspnoea (54.9%). The prevalence of severe or overwhelming rated diarrhea and pruritis were significantly higher in the peritoneal dialysis group than in the hemodialysis group (P=.01 and P=.03, respectively).

Of the 232 participants with baseline data, 145 attended a second clinic appointment. Of those, 122 were on hemodialysis and 23 were on peritoneal dialysis. The second visit occurred a median of 91 days after the initial visit. There were no significant differences in individual symptom burden at the second clinic appointment. However, there was a significant improvement in the subcategory of pruritis in the peritoneal dialysis group at the second clinic visit (mean change, 0.45; P=.02).

In summary, the authors said, “Our results show that patients on peritoneal dialysis have a similar burden of comorbidities and symptoms to patients on hemodialysis, as well as unique symptoms to address. In addition to the five most prevalent symptoms, pruritis and diarrhea were identified as experienced more severely by the peritoneal dialysis cohort. Of these, pruritus was shown to improve between KSC appointments, which may suggest that the interventions commenced at the first appointment were effective.

“These findings also indicate the need for further bowel assessment and management for patients on peritoneal dialysis by KSC clinicians in our health service. This KSC cohort had fewer patients on peritoneal dialysis than hemodialysis. Further studies are needed to elicit if there is a selection bias or if there is an underappreciation for the symptom burden of this cohort, especially given peritoneal dialysis is delivered outside of the hospital system.”

Source: Brand H, Purtell L, Berquier L, et al. Kidney supportive care for patients on peritoneal dialysis: are symptoms being addressed? A retrospective study. Presentation #4315. Abstract of a presentation at the European Renal Association 60th Congress; June 15-18, 2023; Milan, Italy.