Latent profile analysis identifying symptom clusters of fatigue, sleep disturbance, pain, and anxiety and their associations with health-related quality of life and self-efficacy in patients undergoing peritoneal dialysis: a cross-sectional study

BACKGROUND: Peritoneal dialysis patients experience a high burden of co-occurring symptoms that impair health-related quality of life and self-efficacy. This study applied latent profile analysis to identify distinct symptom profiles of fatigue, sleep disturbance, pain, and anxiety and to examine factors associated with profile membership and their associations with patient-reported outcomes. METHODS: In this cross-sectional study conducted from January to October 2025, 308 peritoneal dialysis patients from a tertiary hospital in Shantou, China, completed the Multidimensional Fatigue Inventory-20, Athens Insomnia Scale, Numerical Rating Scale, Zung Self-Rating Anxiety Scale, 36-Item Short Form Health Survey, and Chronic Disease Self-Efficacy Scale. Latent profile analysis was performed using Mplus 8.3. Factors associated with profile membership were examined using exploratory three-step analyses (R3STEP), and differences in health-related quality of life and self-efficacy across profiles were compared using the BCH approach. RESULTS: Three profiles were identified: Low symptom distress (n = 182, 59.1%), Moderate symptom distress (n = 57, 18.5%), and High symptom distress (n = 69, 22.4%). In exploratory R3STEP analyses accounting for classification uncertainty, higher phosphorus was associated with greater odds of membership in the moderate and high symptom distress profiles relative to the low symptom distress profile, while BMI showed a borderline association. BCH analyses further showed significant differences across profiles in physical and mental health-related quality of life and self-efficacy, with the high symptom distress profile showing the poorest outcomes. CONCLUSIONS: Three clinically meaningful symptom profiles exist among peritoneal dialysis patients. Higher symptom distress was associated with poorer health-related quality of life and lower self-efficacy, and exploratory three-step analyses suggested that phosphorus may be an exploratory correlate of membership in the moderate and high symptom distress profiles. These findings suggest that symptom cluster-based screening may help identify peritoneal dialysis patients with greater supportive care needs and may inform future multidisciplinary management strategies.