Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Dec;57(1):2506188.
doi: 10.1080/07853890.2025.2506188. Epub 2025 May 17.

Increased dialysis symptom index burden in maintenance hemodialysis patients during the COVID-19 lockdown period

Wen-Man Zhao  1   2 , Li Zhu  1   2 , Yuyu Zhu  1   2 , Xun-Liang Li  1   2 , Rui Shi  1   2 , Hai-Feng Pan  3   4 , De-Guang Wang  1   2 , Liang Yuan  1   2
Affiliations

Increased dialysis symptom index burden in maintenance hemodialysis patients during the COVID-19 lockdown period

Wen-Man Zhao et al. Ann Med. 2025 Dec.

Abstract

Purpose: The high prevalence of dialysis-related symptoms in maintenance hemodialysis (MHD) patients severely affects their quality of life. Therefore, in this study, we assessed the dialysis symptom index (DSI) of MHD patients during the second wave of COVID-19, which triggered a health crisis, resulting in many cities in China opting for social isolation.

Methods: A total of 106 MHD patients from our center were screened. DSI, sleep quality, and fatigue scales were investigated separately before and during lockdown. Demographic and laboratory data of MHD patients were collected. A nomogram was used to predict high DSI by combining multiple indicators. Additionally, internal validation was performed to reduce overfitting bias.

Results: The mean age of patients was 56.0 years (SD 13.1). The prevalence and severity of DSI were significantly higher during lockdown than pre-lockdown. Notably, itching, trouble staying asleep, bone or joint pain, muscle cramps, feeling irritability, difficulty concentrating, headache, constipation, and feeling nervous were observed (p < 0.05). Multivariate logistic regression analysis identified longer dialysis vintage, lower albumin level, and lower Kt/V as predictors of high DSI. Nomogram showed good accuracy in estimating high DSI with a C-index and bootstrap-corrected index of 0.875 and 0.863, respectively. Calibration plots showed optimal consistency with the actual presence of high DSI.

Conclusion: We found a higher prevalence of DSI in MHD patients during the COVID-19 lockdown. Furthermore, patients with longer dialysis vintage, lower albumin levels, and Kt/V had a risk of developing high DSI.

Keywords: COVID-19; dialysis system index; lockdown; nomogram.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Prevalence of individual symptoms in the maintenance hemodialysis patient cohort before lockdown.
Figure 2.
Figure 2.
Prevalence of individual symptoms in the maintenance hemodialysis patient cohort during lockdown.
Figure 3.
Figure 3.
Nomogram of predictors based on multivariate regression analysis for predicting DSI > 40.
Figure 4.
Figure 4.
Calibration plots of internal validation.
Figure 5.
Figure 5.
A graphical abstract of the study.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kalantar-Zadeh K, Lockwood MB, Rhee CM, et al. . Patient-centred approaches for the management of unpleasant symptoms in kidney disease. Nat Rev Nephrol. 2022;18(3):185–198. doi: 10.1038/s41581-021-00518-z. - DOI - PubMed
    1. Kalantar-Zadeh K, Wightman A, Liao S.. Ensuring choice for people with kidney failure - dialysis, supportive care, and hope. N Engl J Med. 2020;383(2):99–101. doi: 10.1056/NEJMp2001794. - DOI - PubMed
    1. Rhee CM, Nguyen DV, Nyamathi A, et al. . Conservative vs. preservative management of chronic kidney disease: similarities and distinctions. Curr Opin Nephrol Hypertens. 2020;29(1):92–102. doi: 10.1097/mnh.0000000000000573. - DOI - PubMed
    1. Ng MSN, Miaskowski C, Cooper B, et al. . Distinct symptom experience among subgroups of patients with ESRD receiving maintenance dialysis. J Pain Symptom Manage. 2020;60(1):70–79.e71. doi: 10.1016/j.jpainsymman.2020.01.004. - DOI - PubMed
    1. Chaiviboontham S, Phinitkhajorndech N, Tiansaard J.. Symptom clusters in patients with end-stage renal disease undergoing hemodialysis. Int J Nephrol Renovasc Dis. 2020;13:297–305. doi: 10.2147/ijnrd.s271619. - DOI - PMC - PubMed

LinkOut - more resources