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. 2020 Feb;1(2):86-92.
doi: 10.34067/kid.0000072019.

Prevalence and Persistence of Uremic Symptoms in Incident Dialysis Patients

Eugene P Rhee  1   2 , Eliseo Guallar  3 , Seungyoung Hwang  3 , Noori Kim  4 , Marcello Tonelli  5 , Sharon M Moe  6 , Jonathan Himmelfarb  7 , Ravi I Thadhani  1 , Neil R Powe  8 , Tariq Shafi  9
Affiliations

Prevalence and Persistence of Uremic Symptoms in Incident Dialysis Patients

Eugene P Rhee et al. Kidney360. 2020 Feb.

Abstract

Background: Uremic symptoms are major contributors to the poor quality of life among patients on dialysis, but whether their prevalence or intensity has changed over time is unknown.

Methods: We examined responses to validated questionnaires in two incident dialysis cohort studies, the Choices for Health Outcomes in Caring for ESRD (CHOICE) study (N=926, 1995-1998) and the Longitudinal United States/Canada Incident Dialysis (LUCID) study (N=428, 2011-2017). We determined the prevalence and severity of uremic symptoms-anorexia, nausea/vomiting, pruritus, sleepiness, difficulty concentrating, fatigue, and pain-in both cohorts.

Results: In CHOICE and LUCID, respectively, mean age of the participants was 58 and 60 years, 53% and 60% were male, and 28% and 32% were black. In both cohorts, 54% of the participants had diabetes. Median time from dialysis initiation to the symptoms questionnaires was 45 days for CHOICE and 77 days for LUCID. Uremic symptom prevalence in CHOICE did not change from baseline to 1-year follow-up and was similar across CHOICE and LUCID. Baseline symptom prevalence in CHOICE and LUCID was as follows: anorexia (44%, 44%, respectively), nausea/vomiting (36%, 43%), pruritus (72%, 63%), sleepiness (86%, 68%), difficulty concentrating (55%, 57%), fatigue (89%, 77%), and pain (82%, 79%). In both cohorts, >80% of patients had three or more symptoms and >50% had five or more symptoms. The correlation between individual symptoms was low (ρ<0.5 for all comparisons). In CHOICE, no clinical or laboratory parameter was strongly associated with multiple symptoms.

Conclusions: The burden of uremic symptoms among patients on dialysis is substantial and has not changed in the past 15 years. Improving quality of life will require identification of the factors that underlie the pathogenesis of uremic symptoms and better ways of removing the toxins that are responsible.

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Conflict of interest statement

E. Guallar reports grants from the National Institutes of Health (NIH) during the conduct of the study. S. Moe reports personal fees from Amgen, personal fees from Ardelyx, grants from Chugai, grants from Keryx/Akebia, grants from the NIH, and grants from Veterans Administration, outside the submitted work. T. Shafi reports grants from the NIH during the conduct of the study and personal fees from Siemens outside the submitted work. R. Thadhani reports personal fees from Fresenius Medical Care during the conduct of the study. M. Tonelli reports an honorarium from B Braun that was donated to charity and grants from the Canadian Institutes of Health Research during the conduct of the study. J. Himmelfarb, S. Hwang, N. Kim, N. Powe, and E. Rhee have nothing to disclose.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Many individuals in CHOICE and LUCID have multiple uremic symptoms. The y axis shows the percentage of each study cohort (N=926 in CHOICE and N=428 in LUCID) with the corresponding number (#) of uremic symptoms shown on the x axis. CHOICE, Choices for Health Outcomes in Caring for ESRD; LUCID, Longitudinal United States/Canada Incident Dialysis.
See this image and copyright information in PMC

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