Investigation of Core Symptoms during Hemodialysis Period in Chinese Middle-Aged and Young Patients on Maintenance Hemodialysis: A Network Analysis

Background: Recent epidemiological studies have found that the population of young and middle-aged maintenance hemodialysis (MHD) survivors has gradually increased. MHD is one of the most important treatments for patients withend-stage renal disease.Due to renal dysfunction and long-term dialysis treatment, MHD patients are prone to various physiological and emotional symptoms, which seriously affect their quality of life. Network analysis is a new method for estimating and visualizing the structure and interaction of various symptoms of diseases. By identifying core and bridging symptoms, it helps to determine the key mechanisms of symptom occurrence and implement precise interventions for some key symptoms. Methods: A convenience sampling method was used to collect information from 197 young and middle-aged patients at Shanghai Sixth People’s Hospital between November 2023 and February 2024.Dialysis symptom index was used to investigate the prevalence and severity of 30 symptoms in MHD patients，and a symptom network model based on Fruchterman—Reingold algorithm was constructed to analyze the central indicators and deternfine the core symptoms and bridge symptoms． Results: The top five commonly occurring symptoms were dry skin(73.92％)，fatigue(70.6％)，dry mouth(68.37％)，waking up easily(67.82％)and difficulty in falling asleep(66.16％).The most severe symptoms were dry skin，followed by pruritus，fatigue，dry mouth and waking up easily．The symptom network analysis showed that dry skin was most strongly associated with pruritus(weight=0.67) among physiological symptoms，irritability was most strongly associated with anxiety(weight=0.32) among mood symptoms．The centrality index showed that the intensity of sadness was the most centrality(rs=1.65)and was identified as the core symptom；fatigue had the highest mediation centrality(rb=2.76)and irritability had the highest close centrality(rc=1.45)．Irritability，sadness，and inattention were identified as bridge symptoms，and their bridge centrality was 0.34，0.21，and 0.20． Conclusion: Dry skin and sadness are respectively the most severe symptom and core symptom in Chinese middle-aged and young MHD patients，while irritability，sadness and in attention are the bridge symptoms．Medical staff can formulate precise interventions based on core symptoms and bridge symptoms to improve the level of symptom management．