Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Participants and Setting
2.2. Sample Size
2.3. Measures
2.3.1. Symptom Burden
2.3.2. Socio-Demographic Characteristics
2.3.3. Anthropometric Measurements and Clinical Characteristics
2.3.4. Stress
2.3.5. Illness Perception
2.3.6. Social Support
2.4. Ethical Considerations
2.5. Statistics
3. Results
3.1. Patient Characteristics
3.2. Prevalence, and Burden of Symptoms
3.3. Factors Associated with Symptom Burden among Patients on Hemodialysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Baseline n (%) | 6 Months n (%) |
---|---|---|
Age groups | ||
40–55 years | 67 (44.1) | 57 (37.5) |
>56 years | 51 (33.6) | 46 (29.6) |
Gender: | ||
Male | 75 (63.6) | 64 (62.7) |
Female | 43 (36.4) | 38 (37.3) |
Marital status | ||
Unmarried | 5 (4.2) | 5 (4.9) |
Ever married | 113 (95.8) | 97 (95.1) |
Education | ||
Primary | 16 (13.6) | 12 (11.7) |
Secondary | 67 (56.8) | 58 (56.8) |
Tertiary/diploma | 35 (29.7) | 32 (31.5) |
Occupation: | ||
Employed in government/private | 37 (31.3) | 33 (32.3) |
Unemployed | 54 (45.8) | 45 (44.2) |
Self-employed | 27 (22.9) | 24 (23.5) |
Income LKR (USD): | ||
<10,000 LKR (<50) | 17 (14.4) | 16 (13.6) |
10,001–25,000 LKR (50–127) | 46 (39) | 41 (34.7) |
>25,001 LKR (>127) | 55 (46.6) | 45 (38.1) |
Co-morbidities: | ||
Diabetes only | 19 (16.1) | 15 (14.7) |
Hypertension only | 45 (38.1) | 40 (39.2) |
Diabetes and Hypertension | 39 (33.1) | 35 (34.3) |
Others | 15 (12.7) | 12 (11.8) |
Characteristics | Total Mean (SD) | 40–55 Years Mean (SD) | >55 Years Mean (SD) | p |
---|---|---|---|---|
Baseline | ||||
Weight * (kg) a | 58.40 (11.3) | 58.41 (12.6) | 58.40 (8.9) | 0.91 |
Height (cm) a | 164.01 (10.8) | 163.70 (11.4) | 164.42 (10.1) | 0.72 |
BMI (kg/m2) b | 21.86 (4.5) | 21.9 (4.8) | 21.8 (4) | 0.89 |
MpreBP (Hamm) a | 121.79 (20.4) | 122.03 (20.4) | 121.47 (20.6) | 0.88 |
MpostBP (Hgmm) a | 127.04 (21.9) | 125.26 (20.3) | 129.4 (23.9) | 0.31 |
Hb (g/dL) a | 9.20 (1.7) | 8.93 (1.8) | 9.57 (1.6) | 0.05 * |
S.Creatiine (mg/dL) a | 733.23 (329.9) | 750.90 (328.5) | 710 (333.7) | 0.88 |
S.Albumin (g/dL) b | 3.59 (0.7) | 3.59 (0.7) | 3.58 (0.6) | 0.50 |
BUN (mg/dL) a | 16.3 (7) | 16.4 (7) | 15.8 (6.5) | 0.64 |
Stress a | 22.6 (6.5) | 22.64 (6.3) | 22.57 (6.9) | 0.91 |
Illness perception a | 53.4 (9.3) | 53.04 (8.3) | 53.9 (10.6) | 0.63 |
Social support a | 27.6 (7.3) | 27.25 (7.6) | 28.2 (7.09) | 0.51 |
Symptom burden a | 67.04 (22.6) | 66.46 (21.9) | 67.8 (23.7) | 0.74 |
6 months | ||||
Weight * (kg) a | 56.86 (10.6) | 57.4 (11.3) | 56.1 (9.6) | 0.23 |
Height (cm) a | 164.01 (10.7) | 163.6 (11.5) | 164.59 (9.7) | 0.16 |
BMI (kg/m2) b | 21.33 (4.6) | 27.7 (5.1) | 20.9 (1.09) | 0.57 |
MpreBP (Hgmm) a | 117.4 (18.4) | 121.36 (19.65) | 112.04 (15.7) | 0.03 * |
MpostBP (Hgmm) a | 120.1 (16.8) | 122.76 (17.7) | 116.8 (15.8) | 0.63 |
Hb (g/dL) a | 9.45 (1.8) | 9.2 (1.9) | 9.8 (1.6) | 0.47 |
S.Creatiine (mg/dL) a | 703.45 (253.1) | 711.8 (263.4) | 692.9 (241.9) | 0.71 |
S.Albumin (g/dL) b | 4.05 (1.02) | 4.08 (0.9) | 4.01 (1.04) | 0.30 |
BUN (mg/dL) a | 15.48 (5.2) | 14.73 (5.3) | 16.42 (5.1) | 0.49 |
Stress a | 27.3 (5.1) | 27.94 (4.9) | 26.5 (5.3) | 0.11 |
Illness perception a | 56.5 (12.3) | 57.3 (11.7) | 55.56 (13) | 0.43 |
Social support a | 28.6 (6.2) | 28.5 (5.9) | 28.8 (6.7) | 0.70 |
Symptom burden a | 53.1 (29.7) | 55.3 (28.4) | 51.1 (30.8) | 0.41 |
Symptom | Frequency (%) | Prevalence by Age Group n (%) | p | |
---|---|---|---|---|
40–45 Years | >55 Years | |||
Baseline | n = 118 | n = 67 | n = 51 | |
Fatigue b | 115 (97.5) | 64 (95.5) | 51 (100) | 0.17 |
Loss/decreased libido b | 107 (90.7) | 64 (95.5) | 47 (92.2) | 0.55 |
Loss of appetite b | 108 (91.5) | 64 (95.5) | 44 (86.3) | 0.06 |
Swelling b | 109 (94.2) | 61 (91) | 48 (94.1) | 0.39 |
Dry skin b | 109 (94.2) | 61 (91) | 48 (94.1) | 0.38 |
Insomnia b | 107 (90.7) | 61 (91) | 46 (90.2) | 0.56 |
Impotence b | 107 (90.7) | 61 (91) | 46 (90.2) | 0.35 |
Difficulty keeping legs still b | 109 (94.2) | 60 (89.6) | 46 (90.2) | 0.33 |
Nausea b | 107 (90.7) | 60 (89.6) | 47 (92.2) | 0.44 |
6 months | n = 102 | n = 57 | n = 45 | |
Fatigue b | 95 (94.5) | 55 (92.9) | 40 (88.8) | 0.49 |
Insomnia b | 94 (92.2) | 52 (91.2) | 42 (93.3) | 0.21 |
Loss of appetite b | 92 (90.2) | 52 (91.2) | 40 (88.8) | 0.06 |
Difficulty keeping legs still b | 92 (90.2) | 51 (89.5) | 41 (91.1) | 0.52 |
Sadness b | 88 (86.3) | 51 (89.5) | 37 (82.2) | 0.22 |
Dry skin b | 87 (85.3) | 50 (87.7) | 37 (82.2) | 0.31 |
Changes in skin color b | 84 (82.4) | 50 (87.7) | 34 (75.6) | 0.09 |
Lethargy b | 86 (84.3) | 49 (86) | 37 (82.2) | 0.41 |
Joint pain b | 91 (89.2) | 48 (84.2) | 43 (95.6) | 0.06 |
Loss/decreased libido b | 77 (75.5) | 48 (84.2) | 29 (64.4) | 0.02* |
Impotence | 77 (75.5) | 48 (84.2) | 29 (64.4) | 0.02* |
Characteristics | Baseline (n = 118) | 6 Months (n = 102) | ||
---|---|---|---|---|
Mean Rank | U/H/r (p) | Mean Rank | U/H/r (p) | |
Socio-demographic factors | ||||
Age groups: 40–55 years | 58.4 | 1633 c (0.6) | 53.7 | 1155 c (0.4) |
>55 years | 61 | 48.6 | ||
Gender: Male | 60.1 | 1585 c (0.8) | 51 | 1198 c (0.9) |
Female | 59.1 | 51.7 | ||
Marital status: Unmarried | 70.8 | 226 c (0.4) | 56 | 220 c (0.7) |
Ever married | 59 | 51.3 | ||
Education: Up to primary | 59.34 | 1.4 b (0.5) | 45.8 | 1.01 b (0.6) |
Up to secondary | 56.6 | 50.6 | ||
Tertiary | 65 | 55.2 | ||
Income: <10,000 (<50) | 66.8 | 1.09 b (0.6) | 55.7 | 0.4 b (0.8) |
10,000–25000 (50–127) | 59.9 | 51.2 | ||
>25,000 (>127) | 56.9 | 50.3 | ||
Occupation: Employed | 52.2 | 2.8 b (0.2) | 52.2 | 2.8 b (0.2) |
Self employed | 61.2 | 61.2 | ||
Unemployed | 66 | 66.1 | ||
Co-morbidities: DM | 67.7 | 8.6 b (0.03) * | 59.5 | 9.5 b (0.02) * |
HT | 48.6 | 40.8 | ||
DM and HT | 62.6 | 55.8 | ||
Others | 73.9 | 64.6 | ||
Anthropometric and clinical parameters | ||||
Weight (post dialysis) | - | −0.15 a (0.1) | - | −0.22 a (0.02) * |
Height | - | −0.11 a (0.2) | - | −0.06 a (0.5) |
BMI | - | −0.05 a (0.5) | - | −0.15 a (0.14) |
MpreBP | - | 0.07 a (0.5) | - | 0.11 a (0.25) |
MpostBP | - | 0.05 a (0.6) | - | 0.02 a (0.8) |
Hemoglobin (mg/dl) | - | −0.17 a (0.07) | - | −0.16 a (0.9) |
Creatinine (mg/dl) | - | −0.08 a (0.3) | - | −0.05 a (0.6) |
Albumin (mg/dl) | - | 0.03 a (0.8) | - | 0.1 a (0.3) |
BUN | - | 0.14 a (0.1) | - | −0.06 a (0.5) |
Psychosocial factors | ||||
Stress | - | 0.8 a (<0.005) ** | - | 0.34 a (<0.005) ** |
Illness perception | - | 0.7 a (<0.005) | - | 0.24 a (<0.01) * |
Social support | - | −0.14 a (0.14) | - | −0.2 a (0.04) * |
Determinant | 95% CI for β | |||||
---|---|---|---|---|---|---|
USC B | SE | β | p | Lower Bound | Upper Bound | |
Baseline | ||||||
Having hypertension | 1.91 | 2.9 | 0.04 | 0.4 | −3.9 | 7.8 |
Having diabetes and hypertension | −2.75 | 3.3 | −0.05 | 0.5 | −9.2 | 3.7 |
Perceived stress score | 2.26 | 0.3 | 0.65 | <0.005 ** | 1.7 | 2.8 |
Illness perception score | 0.5 | 0.21 | 0.21 | 0.02 * | 0.09 | 0.9 |
6 months | ||||||
Having hypertension | −6.48 | 6.4 | −0.11 | 0.3 | −19.16 | 6.2 |
Having diabetes and hypertension | −7.3 | 7.1 | −0.11 | 0.3 | −21.16 | 6.63 |
Post dialysis body weight | −0.54 | 0.25 | −0.19 | 0.03 * | −1.04 | −0.04 |
Perceived stress score | 1.7 | 0.53 | 0.28 | 0.003 ** | 0.57 | 2.66 |
Illness perception score | 0.5 | 0.23 | 0.2 | 0.03 * | 0.18 | 1.93 |
Social support | −1.05 | 0.44 | −0.22 | 0.02 * | 0.18 | 1.92 |
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Gunarathne, T.G.N.S.; Tang, L.Y.; Lim, S.K.; Nanayakkara, N.; Damayanthi, H.D.W.T.; Abdullah, K.L. Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study. Int. J. Environ. Res. Public Health 2022, 19, 5540. https://doi.org/10.3390/ijerph19095540
Gunarathne TGNS, Tang LY, Lim SK, Nanayakkara N, Damayanthi HDWT, Abdullah KL. Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study. International Journal of Environmental Research and Public Health. 2022; 19(9):5540. https://doi.org/10.3390/ijerph19095540
Chicago/Turabian StyleGunarathne, Thalwaththe Gedara Nadeeka Shayamalie, Li Yoong Tang, Soo Kun Lim, Nishantha Nanayakkara, Hewaratne Dassanayakege Wimala Thushari Damayanthi, and Khatijah L. Abdullah. 2022. "Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study" International Journal of Environmental Research and Public Health 19, no. 9: 5540. https://doi.org/10.3390/ijerph19095540