Kidney Disease Symptoms before and after Kidney Transplantation.
Adult
Aged
Fatigue
/ etiology
Female
Humans
Ichthyosis
/ etiology
Kidney Failure, Chronic
/ complications
Kidney Transplantation
Male
Middle Aged
Myalgia
/ etiology
Postoperative Period
Preoperative Period
Prospective Studies
Pruritus
/ etiology
Quality of Life
Risk Assessment
Symptom Assessment
Waiting Lists
/ mortality
kidney transplantation
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
07
12
2020
accepted:
21
04
2021
entrez:
1
10
2021
pubmed:
2
10
2021
medline:
3
3
2022
Statut:
ppublish
Résumé
Patients with kidney failure report a high symptom burden, which likely increases while on dialysis due to physical and mental stressors and decreases after kidney transplantation due to restoration of kidney function. We leveraged a two-center prospective study of 1298 kidney transplant candidates and 521 recipients (May 2014 to March 2020). Symptom scores (0-100) at evaluation and admission for transplantation were calculated using the Kidney Disease Quality of Life Short-Form Survey, where lower scores represent greater burden, and burden was categorized as very high: 0.0-71.0; high: 71.1-81.0; medium: 81.1-91.0; and low: 91.1-100.0. We estimated adjusted waitlist mortality risk (competing risks regression), change in symptoms between evaluation and transplantation ( At evaluation, candidates reported being moderately to extremely bothered by fatigue (32%), xeroderma (27%), muscle soreness (26%), and pruritus (25%); 16% reported high and 21% reported very high symptom burden. Candidates with very high symptom burden were at greater waitlist mortality risk (adjusted subdistribution hazard ratio, 1.67; 95% confidence interval, 1.06 to 2.62). By transplantation, 34% experienced an increased symptom burden, whereas 42% remained unchanged. The estimated overall symptom score was 82.3 points at transplantation and 90.6 points at 3 months (10% improvement); the score increased 2.75 points per month (95% confidence interval, 2.38 to 3.13) from 0 to 3 months, and plateaued (-0.06 points per month; 95% confidence interval, -0.30 to 0.18) from 3 to 12 months post-transplantation. There were early (first 3 months) improvements in nine of 11 symptoms; pruritus (23% improvement) and fatigue (21% improvement) had the greatest improvements. Among candidates, very high symptom burden was associated with waitlist mortality, but for those surviving and undergoing kidney transplantation, symptoms improved.
Sections du résumé
BACKGROUND AND OBJECTIVES
Patients with kidney failure report a high symptom burden, which likely increases while on dialysis due to physical and mental stressors and decreases after kidney transplantation due to restoration of kidney function.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
We leveraged a two-center prospective study of 1298 kidney transplant candidates and 521 recipients (May 2014 to March 2020). Symptom scores (0-100) at evaluation and admission for transplantation were calculated using the Kidney Disease Quality of Life Short-Form Survey, where lower scores represent greater burden, and burden was categorized as very high: 0.0-71.0; high: 71.1-81.0; medium: 81.1-91.0; and low: 91.1-100.0. We estimated adjusted waitlist mortality risk (competing risks regression), change in symptoms between evaluation and transplantation (
RESULTS
At evaluation, candidates reported being moderately to extremely bothered by fatigue (32%), xeroderma (27%), muscle soreness (26%), and pruritus (25%); 16% reported high and 21% reported very high symptom burden. Candidates with very high symptom burden were at greater waitlist mortality risk (adjusted subdistribution hazard ratio, 1.67; 95% confidence interval, 1.06 to 2.62). By transplantation, 34% experienced an increased symptom burden, whereas 42% remained unchanged. The estimated overall symptom score was 82.3 points at transplantation and 90.6 points at 3 months (10% improvement); the score increased 2.75 points per month (95% confidence interval, 2.38 to 3.13) from 0 to 3 months, and plateaued (-0.06 points per month; 95% confidence interval, -0.30 to 0.18) from 3 to 12 months post-transplantation. There were early (first 3 months) improvements in nine of 11 symptoms; pruritus (23% improvement) and fatigue (21% improvement) had the greatest improvements.
CONCLUSIONS
Among candidates, very high symptom burden was associated with waitlist mortality, but for those surviving and undergoing kidney transplantation, symptoms improved.
Identifiants
pubmed: 34597266
pii: 01277230-202107000-00015
doi: 10.2215/CJN.19031220
pmc: PMC8425607
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1083-1093Subventions
Organisme : NINR NIH HHS
ID : R01 NR017399
Pays : United States
Organisme : NIA NIH HHS
ID : K01 AG064040
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR003100
Pays : United States
Organisme : NINR NIH HHS
ID : F31 NR019461
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL132372
Pays : United States
Organisme : NIAID NIH HHS
ID : K24 AI144954
Pays : United States
Organisme : NHLBI NIH HHS
ID : K24 HL148181
Pays : United States
Organisme : NIA NIH HHS
ID : UH3 AG056933
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 by the American Society of Nephrology.
Références
Murtagh FE, Addington-Hall J, Higginson IJ: The prevalence of symptoms in end-stage renal disease: A systematic review. Adv Chronic Kidney Dis 14: 82–99, 2007 17200048
Caplin B, Kumar S, Davenport A: Patients’ perspective of haemodialysis-associated symptoms. Nephrol Dial Transplant 26: 2656–2663, 2011 21212166
Merkus MP, Jager KJ, Dekker FW, de Haan RJ, Boeschoten EW, Krediet RT: Physical symptoms and quality of life in patients on chronic dialysis: Results of The Netherlands Cooperative Study on Adequacy of Dialysis (NECOSAD). Nephrol Dial Transplant 14: 1163–1170, 1999 10344356
Levy AR, Xing S, Brunelli SM, Cooper K, Finkelstein FO, Germain MJ, Kimel M, Platt RW, Belozeroff V: Symptoms of secondary hyperparathyroidism in patients receiving maintenance hemodialysis: A prospective cohort study. Am J Kidney Dis 75: 373–383, 2020 31629575
Rhee EP, Guallar E, Hwang S, Kim N, Tonelli M, Moe SM, Himmelfarb J, Thadhani RI, Powe NR, Shafi T: Prevalence and persistence of uremic symptoms in incident dialysis patients. Kidney360 1: 86–92, 2020
Abdel-Kader K, Unruh ML, Weisbord SD: Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol 4: 1057–1064, 2009 19423570
Moledina DG, Perry Wilson F: Pharmacologic treatment of common symptoms in dialysis patients: A narrative review. Semin Dial 28: 377–383, 2015 25913502
Flythe JE, Dorough A, Narendra JH, Forfang D, Hartwell L, Abdel-Rahman E: Perspectives on symptom experiences and symptom reporting among individuals on hemodialysis. Nephrol Dial Transplant 33: 1842–1852, 2018 29672712
Cox KJ, Parshall MB, Hernandez SHA, Parvez SZ, Unruh ML: Symptoms among patients receiving in-center hemodialysis: A qualitative study. Hemodial Int 21: 524–533, 2017 27990732
Van Pilsum Rasmussen SE, Warsame F, Eno AK, Ying H, Covarrubias K, Haugen CE, Chu NM, Crews DC, Harhay MN, Schoenborn NL, Segev DL, McAdams-DeMarco MA: Perceptions, barriers, and experiences with successful aging before and after kidney transplantation: A focus group study. Transplantation 104: 603–612, 2020 31283666
Flythe JE, Hilliard T, Lumby E, Castillo G, Orazi J, Abdel-Rahman EM, Pai AB, Rivara MB, St Peter WL, Weisbord SD, Wilkie CM, Mehrotra R; Kidney Health Initiative Prioritizing Symptoms of ESRD Patients for Developing Therapeutic Interventions Stakeholder Meeting Participants: Fostering innovation in symptom management among hemodialysis patients: Paths forward for insomnia, muscle cramps, and fatigue. Clin J Am Soc Nephrol 14: 150–160, 2019 30397026
Perl J, Dember LM, Bargman JM, Browne T, Charytan DM, Flythe JE, Hickson LJ, Hung AM, Jadoul M, Lee TC, Meyer KB, Moradi H, Shafi T, Teitelbaum I, Wong LP, Chan CT; American Society of Nephrology Dialysis Advisory Group: The use of a multidimensional measure of dialysis adequacy-moving beyond small solute kinetics. Clin J Am Soc Nephrol 12: 839–847, 2017 28314806
Flythe JE, Hilliard TS, Ikeler K, Keller S, Gipson DS, Grandinetti AC, Nordyke RJ, Perrone RD, Roy-Chaudhury P, Unruh M, West M, Bocell F, Hurst FP: Toward patient-centered innovation: A conceptual framework for patient-reported outcome measures for transformative kidney replacement devices. Clin J Am Soc Nephrol 15: 1522–1530, 2020
Standardised Outcomes in Nephrology: SONG-HD. 2015. Available at: https://songinitiative.org/projects/song-hd/ . Accessed May 3, 2020
Amro A, Waldum B, Dammen T, Miaskowski C, Os I: Symptom clusters in patients on dialysis and their association with quality-of-life outcomes. J Ren Care 40: 23–33, 2014 24438743
Amro A, Waldum B, von der Lippe N, Brekke FB, Dammen T, Miaskowski C, Os I: Symptom clusters predict mortality among dialysis patients in Norway: A prospective observational cohort study. J Pain Symptom Manage 49: 27–35, 2015 24858738
Bossola M, Di Stasio E, Antocicco M, Panico L, Pepe G, Tazza L: Fatigue is associated with increased risk of mortality in patients on chronic hemodialysis. Nephron 130: 113–118, 2015 26021737
Ozcan H, Yucel A, Avşar UZ, Cankaya E, Yucel N, Gözübüyük H, Eren F, Keles M, Aydınlı B: Kidney transplantation is superior to hemodialysis and peritoneal dialysis in terms of cognitive function, anxiety, and depression symptoms in chronic kidney disease. Transplant Proc 47: 1348–1351, 2015 26093716
Molnar MZ, Novak M, Ambrus C, Szeifert L, Kovacs A, Pap J, Remport A, Mucsi I: Restless legs syndrome in patients after renal transplantation. Am J Kidney Dis 45: 388–396, 2005 15685518
Chu NM, Gross AL, Shaffer AA, Haugen CE, Norman SP, Xue QL, Sharrett AR, Carlson MC, Bandeen-Roche K, Segev DL, McAdams-DeMarco MA: Frailty and changes in cognitive function after kidney transplantation. J Am Soc Nephrol 30: 336–345, 2019 30679381
McAdams DeMarco M, Olorundare I, Ying H, Warsame F, Haugen C, Hall R, Garonzik Wang JM, Desai NM, Walston J, Norman SP, Segev D: Frailty and post-kidney transplant health-related quality of life. Transplantation 102: 291–299, 2018
Kovacs AZ, Molnar MZ, Szeifert L, Ambrus C, Molnar-Varga M, Szentkiralyi A, Mucsi I, Novak M: Sleep disorders, depressive symptoms and health-related quality of life--A cross-sectional comparison between kidney transplant recipients and waitlisted patients on maintenance dialysis. Nephrol Dial Transplant 26: 1058–1065, 2011 20685829
Gordon EJ, Butt Z, Jensen SE, Lok-Ming Lehr A, Franklin J, Becker Y, Sherman L, Chon WJ, Beauvais N, Hanneman J, Penrod D, Ison MG, Abecassis MM: Opportunities for shared decision making in kidney transplantation. Am J Transplant 13: 1149–1158, 2013 23489435
Hemmelgarn BR, Manns BJ, Quan H, Ghali WA: Adapting the Charlson Comorbidity Index for use in patients with ESRD. Am J Kidney Dis 42: 125–132, 2003 12830464
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA; Cardiovascular Health Study Collaborative Research Group: Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56: M146–M156, 2001 11253156
Teng EL, Chui HC: The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry 48: 314–318, 1987 3611032
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49: M85–M94, 1994 8126356
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA 185: 914–919, 1963 14044222
Lawton MP, Brody EM: Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist 9: 179–186, 1969 5349366
Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB: Development of the kidney disease quality of life (KDQOL) instrument. Qual Life Res 3: 329–338, 1994 7841967
Hays RD, Kallich JD, Mapes DL, Coons SJ, Amin N, Carter WB, Kamberg C: Kidney Disease Quality of Life Short Form (KDQOL-SF), Version 1.3: A Manual for Use and Scoring, Santa Monica, CA, Rand, 1997
Korevaar JC, Merkus MP, Jansen MA, Dekker FW, Boeschoten EW, Krediet RT; NECOSAD-study group: Validation of the KDQOL-SF: A dialysis-targeted health measure. Qual Life Res 11: 437–447, 2002 12113391
Peipert JD, Bentler PM, Klicko K, Hays RD: Psychometric properties of the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36) in the United States. Am J Kidney Dis 71: 461–468, 2018 29128411
Tobin J: Estimation of relationships for limited dependent variables. Econometrica 26: 24–36, 1958
Massy ZA: The role of lipids and uremic toxins in cardiovascular disease in CKD. Clin Exp Nephrol 18: 255–256, 2014 24072415
Melamed ML, Plantinga L, Shafi T, Parekh R, Meyer TW, Hostetter TH, Coresh J, Powe NR: Retained organic solutes, patient characteristics and all-cause and cardiovascular mortality in hemodialysis: Results from the retained organic solutes and clinical outcomes (ROSCO) investigators. BMC Nephrol 14: 134, 2013 23806101
Himmelfarb J, Ikizler TA: Hemodialysis. N Engl J Med 363: 1833–1845, 2010 21047227
Meyer TW, Hostetter TH: Uremia. N Engl J Med 357: 1316–1325, 2007 17898101
Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services: Conditions of coverage for end-stage renal disease facilities: Interpretive guidance. Baltimore, MD. April 15, 2008
McAdams-DeMarco MA, Isaacs K, Darko L, Salter ML, Gupta N, King EA, Walston J, Segev DL: Changes in frailty after kidney transplantation. J Am Geriatr Soc 63: 2152–2157, 2015 26416770
Kolonko A, Jurys M, Sirek S, Dwulit T, Pojda-Wilczek D, Więcek A: The effect of maintenance treatment with twice-daily or prolonged once-daily tacrolimus formulation on visual evoked potentials in stable kidney transplant recipients. J Clin Med 9: 1827, 2020 32545305