Sleep complaints, depression and quality of life in Norwegian dialysis patients.

BACKGROUND: This study explores sleep problems in dialysis patients and the associations to health-related quality of life (HRQoL) and depression. A comparison between different validated sleep questionnaires was done in order to find an appropriate diagnostic tool in clinical practice. METHODS: In a cross-sectional study of 301 prevalent dialysis patients, sleep problems were elaborated with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Poor sleep was defined as PSQI score > 5 and daytime sleepiness as ESS > 10. HRQoL, including quality of sleep, was evaluated with the Kidney Disease and Quality of Life - Short Form (KDQoL-SF), and physical (PCS) and mental component summary scores (MCS) were computed. Depression was assessed with Beck Depression Inventory (BDI). RESULTS: Poor sleep and excessive daytime sleepiness was found in 74.3% and 22.2%, respectively. Depression was common (29.5%) and associated with reduced sleep quality (ρ = 0.49, p < 0.001). Poor sleepers had significantly lower MCS (51.8 ± 9.6 vs. 46.6 ± 10.6, p = 0.001) and PCS (41.8 ± 9.6 vs. 35.2 ± 10.0, p < 0.001) compared to good sleepers. PSQI scores were independently associated with PCS (p = 0.001), but not MCS (p = 0.468) in multivariate analyses. The sleep subscale from KDQoL-SF was strongly correlated to PSQI (r = -0.75, p < 0.001). CONCLUSIONS: As sleep complaints, daytime sleepiness and depression were prevalent, all dialysis patients should routinely be screened for self-perceived sleep problems with a simple Questionnaire.

Symptom Clusters From Dialysis to Renal Transplantation: A Five-Year Longitudinal Study.

CONTEXT: Patients on dialysis experience multiple concurrent and often related symptoms defined as symptom clusters. Renal transplantation (RTX) is thought to reduce symptom experience and improve health-related quality of life. No longitudinal study has assessed symptoms and symptom clusters in patients in the transition from dialysis to RTX. OBJECTIVES: We aimed to assess changes in symptom prevalence, identify symptom clusters after RTX, and evaluate the effect of the treatment conversion on predefined symptom clusters. METHODS: A cohort of patients on chronic dialysis (n = 110) was followed prospectively with measurements of health-related quality of life using the Kidney Disease and Quality of Life-Short Form (KDQOL-SF) during dialysis (baseline) and after subsequent RTX. Predefined symptom clusters based on 11 symptoms listed in KDQOL-SF were previously generated using principal component analysis with varimax rotation, that is, uremic (nausea, lack of appetite, dizziness, feeling squeezed out, shortness of breath, and chest pain), neuromuscular (numbness, sore muscle, and cramps), and skin (itching and dry skin) clusters. Stratified analyses were undertaken to identify characteristics associated with change in the symptom clusters after RTX. Cohen's d was used as effect size. RESULTS: Of the 110 patients, mean age was 51.3 ± 14.4 years, and 66% were males. After RTX, the estimated glomerular filtration rate was 54 (interquartile range [IQR] 45-72) mL/minute/1.73 m2. Median follow-up time from assessments during dialysis was 55 (IQR 50-59) months, and follow-up time after RTX was 41 (IQR 34-51) months. The total symptom score improved (73 ± 16 vs. 82 ± 15, P = 0.001, and Cohen's d = 0.6), and the number of symptoms was reduced (6.5 ± 2.6 vs. 4.7 ± 3.0, P = 0.001). Seven symptoms improved statistically after RTX, but only two with Cohen's d > 0.5 (itching and cramps). The scores of the predefined symptom clusters improved after RTX: uremic (82 ± 16 vs. 85 ± 17, P = 0.008, and Cohen's d = 0.2), neuromuscular (66 ± 24 vs. 79 ± 18, P = 0.001, and Cohen's d = 0.6), and skin cluster (62 ± 27 vs. 78 ± 22, P = 0.001, and Cohen's d = 0.6). Symptom clusters could not be generated after RTX. CONCLUSION: Although symptoms and symptom clusters were reduced after RTX, the clinical relevance of the reductions was ambiguous. Symptom clusters could not be generated after RTX, suggesting that use of the KDQOL-SF may not be optimal to assess symptoms in RTX patients.

Symptom clusters predict mortality among dialysis patients in Norway: a prospective observational cohort study.

CONTEXT: Patients with end-stage renal disease on dialysis have reduced survival rates compared with the general population. Symptoms are frequent in dialysis patients, and a symptom cluster is defined as two or more related co-occurring symptoms. OBJECTIVES: The aim of this study was to explore the associations between symptom clusters and mortality in dialysis patients. METHODS: In a prospective observational cohort study of dialysis patients (n = 301), Kidney Disease and Quality of Life Short Form and Beck Depression Inventory questionnaires were administered. To generate symptom clusters, principal component analysis with varimax rotation was used on 11 kidney-specific self-reported physical symptoms. A Beck Depression Inventory score of 16 or greater was defined as clinically significant depressive symptoms. Physical and mental component summary scores were generated from Short Form-36. Multivariate Cox regression analysis was used for the survival analysis, Kaplan-Meier curves and log-rank statistics were applied to compare survival rates between the groups. RESULTS: Three different symptom clusters were identified; one included loading of several uremic symptoms. In multivariate analyses and after adjustment for health-related quality of life and depressive symptoms, the worst perceived quartile of the "uremic" symptom cluster independently predicted all-cause mortality (hazard ratio 2.47, 95% CI 1.44-4.22, P = 0.001) compared with the other quartiles during a follow-up period that ranged from four to 52 months. The two other symptom clusters ("neuromuscular" and "skin") or the individual symptoms did not predict mortality. CONCLUSION: Clustering of uremic symptoms predicted mortality. Assessing co-occurring symptoms rather than single symptoms may help to identify dialysis patients at high risk for mortality.