J HA1,2, A HOFFMAN1, MA BROWN1,2
1Department of Renal Medicine, St George Hospital, Sydney, Australia, 2St George Clinical School, UNSW Medicine, Sydney, Australia
Aim/Background: The symptom burden in end-stage renal disease has been well documented but little is known about the symptom burden in transplant and dialysis patients on home therapies. We extended a previous analysis to compare the symptom burden in haemodialysis (HD), peritoneal dialysis (PD) and renal transplant patients.
Methods: Symptom surveys of transplant, PD, in-centre and home HD patients were conducted using Renal Integrated Palliative care Outcomes Scale (iPOS-Renal) every 6 months from 2015-2017, with 1174 responses from 273 patients. Patients with severe/overwhelming symptoms were referred for Renal Supportive Care.
Results: Overall response rate was 51%; 41% of responders were on in-centre HD (n=113), 31% transplant (n=85) [mean eGFR 51±20 mL/min], 18% PD (n=48) and 10% home HD (n=27). Symptom burden scores (maximum 68) for PD (16±9) and in-centre HD patients (14±9) were higher than transplants (9±8) (p<0.001). Home HD (11±7) and transplant patients had comparable symptom scores (p=0.011). Lack of energy (75%), difficulty sleeping (59%) and poor mobility (55%) were among the commonest symptoms reported. Transplant patients had a similar prevalence of depression (39% vs 46%) but less anxiety (42% vs 56%), compared to dialysis patients. For transplant patients there were weak but significant (p<0.01) relationships between symptom scores and a) time on dialysis prior to transplant and b) eGFR.
Conclusions: The symptom burden of transplant patients is less than that of HD and PD patients but may be under-recognised and is comparable to home HD patients. Importantly, transplant patients report a similar prevalence of depression to dialysis patients, though less anxiety. Routine symptom assessments should be conducted in transplant as well as dialysis patients to aid early identification and management of their symptoms.
Jeffrey is a Nephrology Research Fellow at St George Hospital, Sydney. His research interests include the symptom burden in renal transplant and dialysis patients, as well as the benefits and harms of oral anticoagulation in chronic kidney disease.