Symptom Burden of Older Adults Before and After Dialysis Initiation

Among older patients with kidney failure, lowering the burden of symptoms may be more beneficial than prolonging life. Patients initiating dialysis are affected by kidney failure-related symptoms differently. According to Esther N. M. de Rooji, MD, and colleagues there are few data available on the change in symptoms prior to and following dialysis initiation.

The researchers conducted a study to examine the course of total and individual symptom number and burden before and after dialysis initiation in a cohort of older patients. Results were reported in the Clinical Journal of the American Society of Nephrology [2022;17(12):1719-1729].

The study utilized data from the European Quality (EQUAL) study, an ongoing, prospective, multicenter study in patients ≥65 years of age with an incident estimated glomerular filtration rate (eGFR) ≤20 mL/min/1.73 m². Results were reported in the Clinical Journal of the American Society of Nephrology [2022;17(12):1719-1729].

Using the dialysis symptom index (DSI), 30 symptoms were assessed every 3 to 6 months between 2012 and 2021. Scores for symptom number ranged from 0 to 30 and for burden from 0 to 150 (higher scores indicate more severity). Mixed effects models were used to examine symptoms during the year prior to and the year following initiation of dialysis.

The cohort included 456 incident dialysis patients who completed at least one DSI during the year before and the year after dialysis initiation. At baseline (dialysis initiation) mean age was 76 years, 75% were men, mean eGFR was 8 mL/min/1.73 m², 44% had diabetes, and 46% had cardiovascular disease. In the year prior to dialysis initiation, symptom number increased +3.6 (85% CI, +2.5 to +4.6) and symptom burden increased +13.3 (95% CI, +9.5 to +17.0). Following initiation of dialysis, symptom number changed –0.9 (95%  CI, –3.4 to +1.5) and burden decreased –5.9 (95% CI, –14.9 to –3.0).

“Symptom burden worsened considerably before and stabilized after dialysis initiation,” the researchers said. “Fatigue, decreased interest in sex, and difficulty becoming sexually aroused were considered most burdensome, of which only fatigue somewhat improved after dialysis initiation.”