Predictors of symptom burden among hemodialysis patients: a cross-sectional study at 13 hospitals.

PURPOSE: This study investigated the clinical characteristics and symptomatology of ESRD patients in Jordan taking a multidimensional approach. METHODS: This was a cross-sectional study that included a cohort of 620 patients undergoing maintenance hemodialysis (HD). Data were retrieved via patient survey administration and electronic health records. A modified version of the Charlson Comorbidity index (CCI) was utilized to assess comorbidity. Symptoms were assessed using the validated Arabic version of the CKD Symptom Burden Index (CKD-SBI). RESULTS: The mean (± SD) age of participants was 50.9 ± 16.1 years, with the 59.8% being males. Diabetes was the leading cause of kidney disease among patients (29.2%), followed by hypertension (20.7%) and medication use (8.6%). Common comorbidities included hypertension (72.4%), diabetes (38.4%), and cardiovascular disease (18.7%). Patients experienced 13 CKD-related symptoms on average, with a total symptom burden score of 29.6. Muscle strain was the most common symptom (62.6%), followed by itchiness (59.7%), nervousness (57.7%), and anxiety (57.7%). Charlson comorbidity index (CCI) [ß = 0.88, 95% CI (0.34-1.41)], male gender [ß = - 5.59; 95% CI (- 8.34 to - 2.85)], higher educational level [ß = - 3.38; 95% CI (- 6.39 to - 0.37)], and number of dialysis sessions/week (ß = 6.22, 95% CI 3.37-9.07) were independent predictors of total symptom burden. Similarly, these factors predicted symptom troublesomeness, intensity, and recurrence. CONCLUSION: A holistic clinical picture of ESRD that includes multidimensional symptom assessment is warranted for better disease management and resource allocation. Our paper identifies key characteristic of this population and factors contributing to total symptom burden.

Overactive bladder and associated psychological symptoms: A possible link to vitamin D and calcium.

INTRODUCTION: Overactive bladder (OAB) is a prevalent syndrome that is associated with multiple urinary tract symptoms and could affect the patient's quality of life and well-being. Vitamin D is shown to be linked to OAB syndrome, which exacerbated by stress conditions. This study evaluated the relationship between vitamin D status, daily calcium intake and OAB, and the associated psychological symptoms. METHODS: The study included 55 patients with OAB and 129 healthy controls. Psychological symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Serum vitamin D was measured. Patients with OAB with low vitamin D level received orally vitamin D supplementation. Urinary symptoms, psychological symptoms, and quality of life were evaluated before and after vitamin D supplementation plus dairy products. RESULTS: Vitamin D deficiency was more prevalent in cases (80%) vs controls (34.9%). Depression (43.7% vs 20.2%) and anxiety (52.8% vs 10.9%) scores (HADS, ≥8) were also more frequent in cases vs controls, respectively. Some 85.5% of the patients' group had musculoskeletal pain vs 0.0% for the control. Depression was negatively correlated with daily calcium intake and positively with anxiety. Logistic regression analysis revealed that age, vitamin D, and anxiety scores were significant predictors of OAB. Vitamin D supplements with increased calcium intake had significant improvement in urinary symptoms, psychological distress, and quality of life. CONCLUSIONS: Vitamin D supplements and improved calcium intake may improve urinary and psychological symptoms and quality of life among patients with OAB syndrome. Assessment for vitamin D status in patients with OAB may be warranted.

Cost-Utility Analysis of Apixaban versus Warfarin in Atrial Fibrillation Patients with Chronic Kidney Disease.

BACKGROUND: Warfarin use for stroke prevention in atrial fibrillation (AF) patients with chronic kidney disease is debated. Apixaban was shown to be safer than warfarin, with superior reduction in the risk of stroke, systemic embolism, mortality, and major bleeding irrespective of kidney function. OBJECTIVES: To evaluate the cost-utility of apixaban compared with warfarin in AF patients at different levels of kidney function. METHODS: A Markov model was used to estimate the cost effectiveness of apixaban compared with warfarin in AF patients at three levels of kidney function: estimated glomerular filtration rate (eGFR) of more than 80 ml/min, 50 to 80 ml/min, and 50 ml/min or less. Event rates and associated utilities were obtained from previous literature. The model adopted the US health care system perspective, with hospitalization costs extracted from the Healthcare and Utilization Project. Treatment costs were obtained from official price lists. Univariate and probabilistic sensitivity analyses were performed to evaluate the robustness of results. RESULTS: Apixaban was a dominant treatment strategy compared with warfarin in AF patients with eGFR levels of 50 ml/min or less and 50 to 80 ml/min. In patients with an eGFR of more than 80 ml/min, apixaban was cost-effective compared with warfarin, costing $6307 per quality-adjusted life-year gained. Results were consistent assuming anticoagulant discontinuation after major bleeding events. Compared with dabigatran and rivaroxaban, apixaban was the only cost-effective anticoagulant strategy relative to warfarin in both mild and moderate renal impairment settings. CONCLUSIONS: Apixaban is a favorably cost-effective alternative to warfarin in AF patients with normal kidney function and potentially cost-saving in those with renal impairment.