Symptom Prioritization among Adults Receiving In-Center Hemodialysis: A Mixed Methods Study

Clin J Am Soc Nephrol. 2018 May 7;13(5):735-745. doi: 10.2215/CJN.10850917. Epub 2018 Mar 20.


Background and objectives: Individuals receiving in-center hemodialysis experience a high symptom burden that detrimentally affects their quality of life. There are few evidence-based interventions for symptom relief in this population. To stimulate innovation in symptom management, data on patient symptom prioritization and treatment preferences are needed. We undertook this study to (1) identify patient-prioritized symptoms for the development of symptom relief therapies and (2) elicit preferences for treatments among individuals receiving hemodialysis.

Design, setting, participants, & measurements: We conducted a mixed methods study that included focus groups in Carrboro, North Carolina; Tucson, Arizona; and Seattle, Washington and a nationally distributed online survey. Focus group transcripts were analyzed for patterns, and the highest priority symptoms were determined on the basis of frequency and report severity. We used focus group findings to inform survey items. Focus group and survey results were crossvalidated and synthesized for final symptom prioritization.

Results: There were 32 participants across three focus groups and 87 survey respondents from 27 states in the United States. The physical symptoms of insomnia, fatigue, muscle cramping, and nausea/vomiting and the mood symptoms of anxiety and depressed mood were reported by participants in all focus groups. Among survey respondents, fatigue (94%), cramping (79%), and body aches (76%) were the most common physical symptoms, and feeling depressed (66%), worried (64%), and frustrated (63%) were the most common mood symptoms. The top-prioritized symptoms were consistent across focus group and survey participants and included the physical symptoms insomnia, fatigue, and cramping and the mood symptoms anxiety, depression, and frustration. Participants indicated that symptom frequency, duration, unpredictability, and social and financial effects factored most heavily into symptom prioritization.

Conclusions: Patients prioritized the physical symptoms of insomnia, fatigue, and cramping and the mood symptoms of anxiety, depression, and frustration as the top symptoms for which to find new therapies.

Keywords: Anxiety; ESRD; Emotions; Fatigue; Focus Groups; Frustration; Nausea; Pain; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires; Vomiting; chronic dialysis; depression; dialysis; end-stage renal disease; hemodialysis; quality of life; renal dialysis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Fatigue / epidemiology
  • Female
  • Focus Groups
  • Humans
  • Male
  • Middle Aged
  • Mood Disorders / epidemiology
  • Muscle Cramp / epidemiology
  • Renal Dialysis*
  • Sleep Initiation and Maintenance Disorders / epidemiology