Hemodialysis treatment outcomes and patient-reported outcomes in a single-center pilot study

BACKGROUND. Achieving the best outcomes of dialysis treatment is hindered by limited monitoring of important parameters and lack of consensus on minimum and optimal standards of safety, quality of dialysis, and its organization, which prevents comparative analysis. After running out the possibilities to improve dialysis outcomes by increasing diffusion and convection transfer, the researchers turned to evaluating patient-reported outcomes and ways to improve them. THE AIM. To present the results of a pilot study of symptoms severity and prevalence, as well as their relationship to the treatment characteristics. PATIENTS AND METHODS . In a one-center cohort study, we included 137 patients aged 55±15 years, 41 % women. Symptoms were assessed by the Dialysis Symptom Index, 30 symptoms with a score of 1-5 ("not bothering at all" - "very bothering"). The dialysis monitoring program included monthly/quarterly routine indicators of uremic syndromes correction, assessment of bioimpedance, degree of protein-energy wasting, and sarcopenia. RESULTS . The average symptom score was 50±15 (Me; Q1-Q3: 50, 37-60, from 30 (no symptoms) to 109), a direct relationship was found between the severity and prevalence of symptoms. The overall score in the multiple regression analysis was directly related to the severity of protein-energy wasting (+3.8 points/degree, (95 %CI 0.5-7; p=0.022), phosphate levels (+0.17 points/0.1 mmol/l; (0.03–0.30; p=0.017), and inversely – with hemoglobin level (-0.26 points / 1 g/l; -0.49-(-0.03); p= 0.024), albumin (-0.18 points/1 g/ l; -0.36-(-0.001); p = 0.047), grip power (-0.17 points/1 kg; -0.49-(-0.03); p= 0.024). CONCLUSION. Dialysis patients have a severe symptomatic burden. The symptom clusters demonstrate numerous links with the treatment parameters, which opens up the possibility for targeted interventions in order to achieve better outcomes.