Patients' perspective of haemodialysis-associated symptoms

Introduction. Patients often report symptoms during haemodialysis (HD). To better understand patients' experience, we surveyed routine HD outpatients, to quantify the burden and duration of dialysis-associated symptoms. Methods. Five hundred and eight symptom questionnaires were returned from 550 HD outpatients (92.4%). The symptoms in relation to the HD session were analysed using a visual analogue score. Multivariate logistical regression analysis was used to identify characteristics associated with total symptom burden and time to recover following a HD session. Results. Fifty-four percent of the cohort were male, median age 64 years, 36% diabetic and median age unadjusted Charlson comorbidity score 3.0 (2-5). Fatigue (82%), intradialytic hypotension (76%), cramps (74%) and dizziness (63%) were the commonest symptoms reported, followed by headache (54%), pruritus (52%) and backache (51%), with fatigue occurring with a median frequency of 50% of dialysis sessions and intradialytic hypotension and cramps in 30%. Some 23% reported recovering from dialysis within minutes, 34% by the time they returned home, 16% by bed time, 24% the following morning and 3% just before the next dialysis session. Symptom burden was associated with female sex, younger age, longer duration of dialysis sessions, ethnicity and dialysis centre practice. The time taken to recover from dialysis varied from minutes to hours and was shorter for men and greater dialysis vintage but longer with increasing session time and those with increased intradialytic symptom burden. Conclusions. Despite advances in HD, intradialytic symptoms were frequently reported by our patients. There was substantial unexplained variation in symptom burden across centres, suggesting that clinical practice or policies may play a role in preventing the adverse effects of dialysis. Symptom burden was worse in women, patients of South Asian as opposed to African origin and also in those receiving a longer duration of dialysis. These patients may therefore benefit from a different approach to dialysis prescription.