Clinical events and patient-reported outcome measures in peritoneal dialysis

Background Traditional markers of dialysis adequacy in peritoneal dialysis (PD) correlate poorly with both patient symptoms and outcomes, and residual kidney function remains the better determinant of each. Largely in response to these findings, guidelines now recommend focussing on patient-reported outcome measures (PROMs) in addition to assessing dialysis adequacy, where they have been shown to predict mortality, technique survival and hospitalisations. We aim to assess whether symptom burden measured by Palliative care Outcome Scale Symptom (POS-S)-renal questionnaire correlate with traditional markers of dialysis adequacy and is associated with future patient outcomes. Hypothesis We hypothesise that the POS-S renal score does not correlate with traditional markers of dialysis adequacy but that it might be associated with future outcomes including mortality, technique survival and hospitalisations. Method This was a retrospective study on adult PD patients who underwent a POS-S-renal questionnaire within 2-weeks of their routine Peritoneal Equilibrium Test (PET)-Adequest test. We assessed for the association between POS-S renal scores with adequacy measures (Kt/V and creatinine clearance or CCr) and whether POS-S renal scores were associated with future outcomes (remaining on PD, transition to haemodialysis, kidney transplantation or death on PD). Results There were 107 patients with at least one paired PET-Adequest and POS-S renal questionnaire. There was no correlation between markers of dialysis adequacy (CCr and Kt/V) and symptom burden measured by POS-S renal questionnaire. Higher symptom burden was associated with less favourable outcomes including technique failure, hospitalisations and death (p < 0.05). There was also an association between a higher symptom burden and a lower serum albumin level (p < 0.001). Conclusion There was no association between markers of dialysis adequacy and the POS-S renal score; however, a higher POS-S renal score was associated with technique failure, hospitalisations and death compared to traditional markers. The measurement of PROMs may provide a beneficial addition to dialysis assessment in routine PD care.