Impact of Pain and Symptom Burden on the Health-Related Quality of Life of Hemodialysis Patients

Context. Dialysis patients experience tremendous symptom burden and substantial impaired health-related quality of life (HRQL). Objectives. We determined the association between symptom burden and HRQL in 591 hemodialysis patients. Methods. Patients completed the modified Edmonton Symptom Assessment System and the Kidney Dialysis Quality of Life Short Form at baseline and after six months. Results. There were no demographic, serological, or dialysis-related predictors for either HRQL or symptom burden. Pain, tiredness, lack of well-being, and depression were the only independent predictors of mental HRQL, accounting for 42.5% of the variation in the baseline mental health composite (MHC). Pain, fatigue, lack of wellbeing, and shortness of breath were the only independent predictors of physical HRQL, accounting for 38.5% of the variation in the baseline physical health composite (PHC). After follow-up, only changes in depression, anxiety, tiredness, and lack of appetite were independently associated with a change in MHC score, accounting for 48.7% of the variability. Only changes in pain, tiredness, and lack of appetite were independently associated with a change in PHC, accounting for 44.6% of the variability in the final multivariate regression model. No change in biochemical parameters predicted a change in either the MHC or the PHC. Conclusion. Symptom burden in end-stage renal disease was substantial and had a tremendous negative impact on all aspects of hemodialysis patients' HRQL. These patients, therefore, would likely benefit from the institution of programs to reduce symptom burden. J Pain Symptom Manage 2010;39:477-485. (C) 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.