Could symptom burden predict subsequent healthcare use in patients with end stage kidney disease on hemodialysis care? A prospective, preliminary study

Jing C. Zhang, Salam El-Majzoub, Madeline Li, Tibyan Ahmed, Joyce Wu, Mark L. Lipman, Ghizlane Moussaoui, Karl J. Looper, Marta Novak, Soham Rej, Istvan Mucsi

Research output: Contribution to journalArticle

Abstract

Context: Patients treated with maintenance hemodialysis experience significant symptom burden resulting in impaired quality of life. However, the association of patient reported symptom burden and the risk of healthcare use for patients with end stage kidney disease on hemodialysis has not been fully explored. Objectives: To investigate if higher symptom burden, assessed by the Edmonton Symptom Assessment System-revised (ESASr), is associated with increased healthcare use in patients with end stage kidney disease on hemodialysis. Methods: Prospective, single-center, study of adult patients on HD. Participants completed the ESASr questionnaire at enrollment. Baseline demographic, clinical information as well as healthcare use events during the 12-month following enrollment were extracted from medical records. The association between symptom burden and healthcare use was examined with a multivariable adjusted negative binomial model. Results: Mean (SD) age of the 80 participants was 71 (13) years, 56% diabetic, and 70% male. The median (IQR) dialysis vintage was 2 (1–4) years. In multivariable adjusted models, higher global [incident rate ratio (IRR) 1.02, 95% confidence interval (CI) 1.00–1.04, p =.025] and physical symptom burden score [IRR 1.03, CI 1.00–1.05, p =.034], but not emotional symptom burden score [IRR 1.05, CI 1.00–1.10, p =.052] predicted higher subsequent healthcare use. Conclusions: Our preliminary evidence suggests that higher symptom burden, assessed by ESASr may predict higher risk of healthcare use amongst patients with end stage kidney disease on hemodialysis. Future studies need to confirm the findings of this preliminary study and to assess the utility of ESASr for systematic symptom screening.

Original languageEnglish
Pages (from-to)294-301
Number of pages8
JournalRenal failure
Volume42
Issue number1
DOIs
Publication statusPublished - Jan 1 2020

Keywords

  • Edmonton Symptom Assessment System-revised
  • Maintenance hemodialysis
  • end-stage kidney disease
  • healthcare use

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Nephrology

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