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Prevalence, Severity, and Importance of Physical and Emotional Symptoms in Chronic Hemodialysis Patients

Steven D. Weisbord^*, Linda F. Fried^*, Robert M. Arnold, Michael J. Fine, David J. Levenson, Rolf A. Peterson^¶ and Galen E. Switzer^||

^* Center for Health Equity Research and Promotion and Renal Section, VA Pittsburgh Healthcare System and the Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Division of General Internal Medicine, Department of Medicine, Section of Palliative Care and Medical Ethics, Center for Bioethics and Health Law, Institute for Performance Improvement, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System and Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Department of Medicine, University of Pittsburgh School of Medicine; and ^|| Departments of Medicine and Psychiatry and the Center for Research on Health Care, University of Pittsburgh School of Medicine and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and ^¶ Department of Psychology, The George Washington University, Washington, DC

Address correspondence to: Dr. Steven D. Weisbord, VA Pittsburgh Healthcare System, Renal Section 7E, Room 120, Mailstop 111F-U, Pittsburgh, PA 15240. Phone: 412-688-6000; Fax: 412-688-6908; E-mail: steven.weisbord{at}med.va.gov

Received for publication February 10, 2005. Accepted for publication May 8, 2005.

The prevalence, severity, and clinical significance of physical and emotional symptoms in patients who are on maintenance hemodialysis remain incompletely characterized. This study sought to assess symptoms and their relationship to quality of life and depression. The recently developed Dialysis Symptom Index was used to assess the presence and the severity of 30 symptoms. The Illness Effects Questionnaire and Beck Depression Inventory were used to evaluate quality of life and depression, respectively. Correlations among symptom burden, symptom severity, quality of life, and depression were assessed using Spearman correlation coefficient. A total of 162 patients from three dialysis units were enrolled. Mean age was 62 y, 48% were black, 62% were men, and 48% had diabetes. The median number of symptoms was 9.0 (interquartile range 6 to 13). Dry skin, fatigue, itching, and bone/joint pain each were reported by 50% of patients. Seven additional symptoms were reported by >33% of patients. Sixteen individual symptoms were described as being more than "somewhat bothersome." Overall symptom burden and severity each were correlated directly with impaired quality of life and depression. In multivariable analyses adjusting for demographic and clinical variables including depression, associations between symptoms and quality of life remained robust. Physical and emotional symptoms are prevalent, can be severe, and are correlated directly with impaired quality of life and depression in maintenance hemodialysis patients. Incorporating a standard assessment of symptoms into the care provided to maintenance hemodialysis patients may provide a means to improve quality of life in this patient population.

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