MO476: Prevalence of Symptoms in End Stage Renal Disease and Their Association With Quality of Life
Authors: Nabil Hamouche , Chettati Mariam , Fadili Wafaa , Laouad Inass 
Published: May 2022

BACKGROUND AND AIMS

End-stage chronic renal disease (ESRD) is an irreversible disease with serious consequences for the life of the patient and perceived as a social and professional handicap. Management of ESRD therefore requires not only control of symptoms and morbidity, but also improvement in the quality of life (QoL) of these patients.

Due to its wide variety of symptoms as well as the cost/dialysis patient, ESRD is one of the most expensive pathologies in the world, making it the subject of several studies.

The aim of this study was to study the prevalence and influence of symptoms on the physical and mental components of the QoL in patients with ESRD, both in those on pre-dialysis as well as in those already at the stage of hemodialysis.

METHOD

This is a cross-sectional observational study carried out between January and April 2021. This multicenter study concerned a cohort of 245 patients with end-stage chronic renal failure on dialysis or on pre-dialysis.

Upon entry into the study, a set of 17 symptoms was collected by patient interview or by patient self-administered questionnaire. Patients’ QOL was assessed using the physical (PCS) and mental (MCS) summary components of the `Kidney Disease Quality of Life Short Form’ (KDQoL SF-36). Single and multiple logistic and linear regression analyzes were used to compare symptoms and their impact on QoL between predialysis and dialysis.

A P-value &lt; .05 in a confidence interval &gt;95% is considered statistically significant.

RESULTS

Among the 245 patients included, 102 were on pre-dialysis and 143 were in the hemodialysis stage.

The mean age of all of our patients was 54.21 ± 11.07 years old with extremes of 19–81 years old and predominantly male (63%).

Causal nephropathy was undetermined in 53% of cases; 44% of our patients had hypertension under treatment, and 38% were diabetic.

The most common symptoms are sleep disorders (71%), anorexia (48%), muscle pain (26%), weight loss (26%), loss of autonomy and chest pain (21%), asthenia and then libido disorders (20%). Among our patients, 46% still had residual kidney function. Only cramps and fatigue were significantly associated with a decline in kidney function.

Symptoms such as asthenia, sleep disturbances, along with restless legs syndrome and pruritus were significantly different in the two groups, being more common in dialysis patients.

In univariate analysis, the comparative study of the different components of the score found a statistically significant association between the mental component of the scoring and the age, the female sex, the feeling of burden in relation to the family, the quality of dialysis (Kt/V) and pruritus. In contrast, the duration of kidney disease, loss of residual kidney function and anemia were associated with increased kidney disease burden and physical component.

In multivariate analysis, the presence of cardiovascular disease increased the risk of clinically poor QoL, and age &gt;60 years increased the risk of having poor QoL. On the contrary, having the ability to do the work at home as well as a good relationship with caregivers are factors of good QoL mentally, and seniority in HD &gt; 5 years had a positive impact on physical QoL.

CONCLUSION

The QoL during ESRD is a complex notion that results from an interaction of several components: the disease itself, the patient's psychological traits, the patient's behavior in the face of his illness and social support.

Despite this complexity, it must be considered as a criterion for evaluating the means of substitution offered in IRCT.

Finally, the QoL after kidney transplant remains much higher than that offered by dialysis despite the risk of complications related to immunosuppressants.