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. 2020 Nov;42(1):294-301.
doi: 10.1080/0886022X.2020.1744449.

Could symptom burden predict subsequent healthcare use in patients with end stage kidney disease on hemodialysis care? A prospective, preliminary study

Jing C Zhang  1 , Salam El-Majzoub  2 , Madeline Li  3 , Tibyan Ahmed  1 , Joyce Wu  2 , Mark L Lipman  4 , Ghizlane Moussaoui  2 , Karl J Looper  2 , Marta Novak  5   6 , Soham Rej  2 , Istvan Mucsi  1
Affiliations

Could symptom burden predict subsequent healthcare use in patients with end stage kidney disease on hemodialysis care? A prospective, preliminary study

Jing C Zhang et al. Ren Fail. 2020 Nov.

Abstract

Context: Patients treated with maintenance hemodialysis experience significant symptom burden resulting in impaired quality of life. However, the association of patient reported symptom burden and the risk of healthcare use for patients with end stage kidney disease on hemodialysis has not been fully explored.Objectives: To investigate if higher symptom burden, assessed by the Edmonton Symptom Assessment System-revised (ESASr), is associated with increased healthcare use in patients with end stage kidney disease on hemodialysis.Methods: Prospective, single-center, study of adult patients on HD. Participants completed the ESASr questionnaire at enrollment. Baseline demographic, clinical information as well as healthcare use events during the 12-month following enrollment were extracted from medical records. The association between symptom burden and healthcare use was examined with a multivariable adjusted negative binomial model.Results: Mean (SD) age of the 80 participants was 71 (13) years, 56% diabetic, and 70% male. The median (IQR) dialysis vintage was 2 (1-4) years. In multivariable adjusted models, higher global [incident rate ratio (IRR) 1.02, 95% confidence interval (CI) 1.00-1.04, p = .025] and physical symptom burden score [IRR 1.03, CI 1.00-1.05, p = .034], but not emotional symptom burden score [IRR 1.05, CI 1.00-1.10, p = .052] predicted higher subsequent healthcare use.Conclusions: Our preliminary evidence suggests that higher symptom burden, assessed by ESASr may predict higher risk of healthcare use amongst patients with end stage kidney disease on hemodialysis. Future studies need to confirm the findings of this preliminary study and to assess the utility of ESASr for systematic symptom screening.

Keywords: Edmonton Symptom Assessment System-revised; Maintenance hemodialysis; end-stage kidney disease; healthcare use.

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Conflict of interest statement

SR receives an investigator-initiated research grant from Satellite Healthcare (dialysis company) for an unrelated project. The remaining authors have no competing interests to report.

Figures

Figure 1.
Figure 1.
Flow diagram of participant selection (July 2015 to Aug 2016).
Figure 2.
Figure 2.
Prevalence of nine moderate/severe distress of individual symptoms in patients with ESKD.
See this image and copyright information in PMC

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