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. 2019 Dec 20;2(2):125-130.
doi: 10.1016/j.xkme.2019.10.010. eCollection 2020 Mar-Apr.

Intradialytic Symptoms and Recovery Time in Patients on Thrice-Weekly In-Center Hemodialysis: A Cross-sectional Online Survey

Luis Alvarez  1 , Deborah Brown  2 , Dean Hu  3 , Glenn M Chertow  4 , Joseph A Vassalotti  5   6 , Sarah Prichard  7
Affiliations

Intradialytic Symptoms and Recovery Time in Patients on Thrice-Weekly In-Center Hemodialysis: A Cross-sectional Online Survey

Luis Alvarez et al. Kidney Med. .

Abstract

Rationale & objective: Patients experience various symptoms during hemodialysis. We aimed to assess the frequency and severity of symptoms during hemodialysis and whether intradialytic symptoms are associated with recovery time postdialysis.

Study design: An online questionnaire was sent to 10,000 patients in a National Kidney Foundation database.

Setting & participants: Adult patients receiving in-center hemodialysis 3 times weekly for 3 or more months.

Exposure: Online questionnaire.

Analytic approach: Tabulation of frequency and severity of events and recovery time as percent of respondents, construction of a total symptom score, followed by rank correlation analysis of symptom characteristics with total recovery time.

Outcomes: Patient-reported intradialytic symptoms and recovery time postdialysis.

Results: 359 patients met screening criteria and completed the questionnaire. Mean age was 62.5 ± 13.8 years, 207 (58%) were men, 74 (21%) were black/African American, 132 (37%) had diabetes, 252 (70%) had hypertension, and 102 (28%) had a history of myocardial infarction, heart surgery, or stent placement. 311 (87%) patients had symptoms during dialysis in the previous week, with mean severity of 2.7 (range for each symptom, 1-5). The most common symptoms were fatigue/feeling washed out (62%), cramps (44%), and symptoms of low blood pressure (42%). Median time to recovery was 3 (range, 0-24) hours, and this correlated with the incidence and severity of intradialytic symptoms (P < 0.0001). 40% of patients had time to recovery times of 4 hours or longer. 1 in 3 patients reported having stopped dialysis early for intradialytic symptoms and 6% reported skipping dialysis at least once because of intradialytic symptoms.

Limitations: Recall-based self-reported data with a relatively low response rate.

Conclusions: A majority of patients receiving in-center hemodialysis experience symptoms such as feeling washed out, fatigue, and cramping; these may be severe and are correlated with longer recovery time following hemodialysis, as well as shortened and skipped hemodialysis sessions.

Keywords: hemodialysis; recovery time; symptoms.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Prevalence and severity of reported symptoms. (Left panel) Percent of patients who report having each of the 12 symptoms in the questionnaire during their 3 dialysis sessions in the previous week. (Right panel) Mean severity reported for each of the 12 symptoms.
Figure 2
Figure 2
Percent of patients by number of symptoms per patient.
Figure 3
Figure 3
Recovery time postdialysis.
Figure 4
Figure 4
Relationship of recovery time versus number of symptoms. The correlation coefficient of recovery time as a function of number of symptoms per patient is 0.275 (P < 0.0001). Abbreviation: CI, confidence interval.
Figure 5
Figure 5
Relationship of recovery time versus total symptom score. Total symptom score for each patient was calculated by number of symptoms multiplied by the average severity of the symptoms. The correlation coefficient of recovery time as a function of the total symptom score is 0.279 (P < 0.0001). Abbreviation: CI, confidence interval.
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