Renal Provider Perceptions and Practice Patterns Regarding the Management of Pain, Sexual Dysfunction, and Depression in Hemodialysis Patients

Background: Although pain, sexual dysfunction, and depression are common in patients receiving chronic hemodialysis, these symptoms frequently remain untreated. We sought to characterize renal provider perceptions and practice patterns regarding the treatment of these symptoms. Methods: We surveyed renal providers whose patients were participating in a clinical trial of symptom management at nine hemodialysis units in southwestern Pennsylvania. We used Spearman's correlation to assess the association of provider characteristics with the reported frequency of providing treatment. Results: Overall, 27 of 35 (77%) providers completed the survey. While 21 (78%) believed symptom management to be very important and 23 (85%) reported spending a moderate to a lot of time managing symptoms, <50% reported treating pain and <20% reported treating sexual dysfunction or depression most or all of the time. Most providers believed it was nonrenal providers' responsibility to treat these symptoms. A greater reported comfort level managing symptoms was associated with a higher reported frequency of treating pain (r = 0.6; p < 0.01), sexual dysfunction (r = 0.67; p < 0.01), and depression (r = 0.43; p < 0.03). Providers who believed it was nonrenal providers' responsibility to treat these symptoms reported treating pain (r = -0.62; p < 0.01) and depression (r = -0.48; p = 0.02) less frequently. Conclusions: Despite reporting considerable importance and substantial time managing symptoms in general, renal providers commonly describe not treating pain, sexual dysfunction, and depression in hemodialysis patients. Given renal providers' beliefs that nonrenal clinicians are primarily responsible for treating these symptoms, multidisciplinary approaches to symptom management in these patients are needed.