Symptoms and their recognition in adult haemodialysis patients: Interactions with quality of life

Aim: We investigated the symptom burden in adults on haemodialysis, the recognition of symptoms by nurses and nephrologists, and the relationship between symptoms and quality of life. Methods: In this cross-sectional observational study, symptoms and quality of life in haemodialysis patients were determined using validated surveys. Nurses and nephrologists independently estimated their patients' symptoms, and these estimates were compared with patient responses (sensitivity; kappa values for interrater agreement). Associations between symptoms and quality of life were assessed using multi-level regression. Results: Forty-three patients, 18 nurses and 3 nephrologists participated. The commonest symptoms (95%CI) reported by patients were weakness, 69% (53 to 82); poor mobility, 44% (29 to 60); and drowsiness, 44% (29 to 60). Sensitivity less than 50% was seen towards 11 of 17 symptoms in nurse ratings compared with 15 of 17 in nephrologist ratings. Agreement with patient symptom ratings was mostly fair ' (0.21-0.4), with nurses ' scores showing greater agreement than nephrologists'. Physical, mental and kidney disease component summary scores of quality of life were negatively associated with total symptom score and the number of major ' symptoms (r(2) values 0.3-0.36); while with multivariate regression, 50% to 60% of the variance in these scores was accounted for by parsimonious models containing symptoms such as pain and poor mobility. Conclusion: Symptom burden worsened quality of life scores in haemodialysis patients. Clinician recognition of symptom burden was inaccurate, although nurses were more accurate than nephrologists. Using patient-completed surveys or including dialysis nurse feedback in routine outpatient settings may help improve symptom recognition by nephrologists.