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Nephrology (Carlton). 2018 Oct 8. doi: 10.1111/nep.13509. [Epub ahead of print]

Patient-Reported outcome measures and their utility in the management of patients with advanced chronic kidney disease.

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Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, Victoria.
Department of Medicine, St Vincent's Hospital, Melbourne University.
Department of Palliative Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria.
Centre for Palliative Medicine, Fitzroy, Victoria.
School of Rural Health, Monash Health, Clayton, Victoria.


Symptom and quality of life (QOL) measures in patients with advanced chronic kidney disease (CKD) are recognised indicators of patient-centred care and represent important research, quality and clinical measures. This study examined relationships between symptom burden, QOL and functional status and associations of symptoms and mortality risk. A multisite longitudinal cohort analysis was undertaken in CKD stage 4/5 (no dialysis, ND) and dialysis patients. Patients completed symptom and QOL measures (Palliative Care Outcome Symptom Score (POS-S renal) [1], World Health Organisation QOL, WHOQOL-BREF) [2] and Karnofsky Performance scale [3]. Clinical and demographic data were recorded. Participants recruited were 112 dialysis and 40 ND patients. High symptom burden was present and correlated with lower QOL, QOL subdomains and reduced performance status. Comparing groups found a small significant difference in physical QOL suggesting dialysis treatment burden. Further analysis was restricted comparing 102 dialysis and 31 CKD stage 4 (CKD4) patients. Dialysis patients had above target adequacies, but poorer appetite, nausea, vomiting and difficulty sleeping compared with CKD4 patients. Overall, the most prevalent symptoms were also the most severe, specifically pain, dyspnea, weakness, difficulty sleeping. Cox Proportional Hazards regression showed severe pain, nausea, vomiting, poor mobility, itch and skin changes were significantly associated with shorter survival in dialysis patients. Severe symptom score was associated with mortality risk (HR 1.1, 95%CI(1.03,1.17) compared with no increased risk with comorbidity score or age. Patients with advanced CKD had significant symptom burden correlated with poorer QOL. Symptoms may also be useful in considering clinical outcomes, specifically mortality. This article is protected by copyright. All rights reserved.


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