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Value Health Reg Issues. 2019 Jan 10;20:28-35. doi: 10.1016/j.vhri.2018.10.003. [Epub ahead of print]

Prevalence of Symptoms and Symptom Clusters of Patients on Dialysis in Uruguay.

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Medical Psychology Department, Faculty of Medicine, Universidad de la República, Uruguay.
Medical Psychology Department, Faculty of Medicine, Universidad de la República, Uruguay. Electronic address:
Unit of Biometrics, Institute of Statistics, Faculty of Economics and Administration, Universidad de la República, Uruguay.
Departments of Nephrology and Physiopathology, Faculty of Medicine, Universidad de la República, Uruguay.



Patients on dialysis report high levels of symptom burden. The association of these symptoms may have an increased deleterious effect on the patients' well-being.


This study aimed to assess the prevalence of symptoms, to identify symptom clusters, and to describe the impact of concurrent symptoms on physical and emotional well-being in a sample of dialysis patients.


Data of the first assessment of a longitudinal study aimed to assess patient-reported outcomes in dialysis were included here. The KDQOL-36 PCS, MCS and Symptom Subscale, the Hospital Anxiety and Depression Scales and the Epworth Sleepiness Scale were analyzed. The ICLUST procedure was followed for hierarchical cluster analyses.


Of the 512 eligible patients, 493 accepted to participate, 43.6 % were female, with mean age of 60.9 (SD=16.7). Treatment modality was HD in 87.6% of patients. Most prevalent and severe symptoms were muscle sores, cramps, "washed out", dry skin, and itchy skin, Moderate to severe pain was reported by 25%, and daily somnolence by 12.4% of the patients. Five first level symptom clusters were identified as cutaneous, cardiac, digestive, sensory-motor, energy. Both, the presence of any cluster and cluster scores were significantly associated with lower physical and mental quality of life and a higher psychological distress.


Our study confirms the presence of high symptom burden in dialysis patients in Uruguay. Several symptom clusters were identified having significant impact on the patients' well-being. The identification of symptom clusters can help to understand common underlying pathways. It is possible that the management of symptom clusters may reduce symptom burden in these patients.


Uruguay; dialysis; hierarchical cluster analysis; symptom clusters


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