Symptom Burden And Its Influence Factors Among Patients Receiveing Maintenance Hemodialysis:a Cross Sectional Study

Objective The aim of this thesis is to survey the symptom burden of patients receiving maintenance hemodialysis, and its related factors, so as to provide a basis for clinical symptom management.Methods This was a single center cross-sectional study. Convenience sampling was used to selected patients receiving maintenance hemodialysis patients from a hospital in Hangzhou during May 2015 to September 2015. Symptom burden was measured using Dialysis Frequency Severity and Symptoms Burden Index (DFSSBI). This index contains 30 symptoms and the highest score is 360 points. Also the social demographic characteristics and the relevant clinical information were collected to find out the influencing factors of symptom burden for patients receiving maintenance hemodialysis.Results (1) Totally 191 patients receiving maintenance hemodialysis were included, the scores of symptom burden in all patients were 50.86±27.98 points, among which the physical symptoms scores was 43.29±23.73, and the psychological symptoms scores was 7.56±7.08. The differences of the symptoms burden score and the physical symptoms score among different age groups were statistically significant (F=3.788, P<0.05; F=4.64, P<0.05), and the symptom burden of the youth group were the lowest (38.35±21.178), and which was significantly lower compared to other three groups and it mainly reflected on the dimension of physical symptoms score. The difference of symptoms burden score and the psychological symptoms score among groups of dialysis years was statistically significant (F=2.993,P<0.05; F=5.29,P<0.005): symptom burden of patients receiving hemodialysis within one year were the heaviest (67.89±32.72), and statistically significant in symptom burden score with the 1～5 years group and 5～10 years group, and their psychology symptoms were statistically significant with the other groups. (2) In all symptoms, the most common symptoms were fatigue, itching, dry mouth, dry skin and dizziness; the most frequent symptoms were dry skin, dry mouth, loss of appetite, difficulty falling asleep and easy to wake up; the most severe symptoms were restless legs syndrome, difficulty falling asleep, easy to wake up, foot numbness tingling and bone or joint pain; and the most distressed symptoms were restless legs syndrome, bone or joint pain, foot numbness, tingling, muscle aches, and difficulty falling asleep. (3) Correlation analysis showed that symptom burden score was correlated with gender (rs=0.302,P=0.000), age (r=0.177,P=0.014), income (rs=-0.248,P=0.001), education level (rs=-0.173,P=0.017), working status(rs=0.172,P=0.018), iPTH (rs=0.165,P=0.022), Ca(r=0.220,P=0.002), Ca*P (r=0.148,P=0.041). But marital status, dialysis years, whether having diabetes mellitus, ALB, Hb, Scr, Bun, UA, P were not correlated with symptom burden score. Multiple linear regression analysis indicated that gender, age, income and iPTH had linear regression relationship with the coefficient of determination(R2=0.216).Conclusion Maintenance hemodialysis patients suffer from a large symptom burden, many of their symptoms occured simultaneously, and their incidence, frequency, severity and distress were inconsistent, so we recommend clinical staffs to assess patient’s symptoms comprehensively and multi-dimensionally. (2) Laboratory indicators cannot fully reflect the disease status of patients, so symptom burden may be used as one of the standards for dialysis. Quality evaluation (3) Although the incidence of some symptoms is very low, they have a great impact on patients, for example, the prevalence of restless legs syndrome was just 11.5%, but with a large impact on patients. So clinical staff should pay attention to these symptoms. (4) Symptoms burden of elderly patients was more severe than young patients, and the physical symptoms of elderly patients was relatively more serious; the symptom burden of patients receiving hemodialysis within one year was more serious than those of patients over one year, especially psychological symptom so measures should be taken depending on patients’characteristics.