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New Study Examines Symptom Burden Before and After Starting Dialysis in Older Adults

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In a study published in the Clinical Journal of the American Society of Nephrology that included older adults with kidney failure, symptoms related to their condition worsened in the year before patients started dialysis but stabilised after dialysis initiation.

For older people with kidney failure, lessening their symptom burden can help to improve their quality of life. By analysing data from the European Quality (EQUAL) study, an ongoing prospective multicenter study in patients aged 65 years and older with advanced chronic kidney disease, Esther N.M. de Rooij, MD (Leiden University Medical Center, in The Netherlands) and her colleagues investigated the course of total and individual symptom number and burden before and after 456 patients with kidney failure started dialysis.

Thirty symptoms were assessed every 3–6 months between 2012 and 2021, with scores for symptom number ranging from 0 to30 and for symptom burden ranging from 0–150 (with higher scores indicating more severity).

‘Dialysis initiation may affect individual kidney failure-related symptoms differently. However, the change in symptoms before and after the start of dialysis in older patients has not been studied before,’ said Dr. de Rooij.

The analysis revealed that in the year before dialysis initiation, symptom number increased by +3.6 and symptom burden increased by +13.3. In the year after, the symptom number decreased by –0.9 and the burden decreased by –5.9. At dialysis initiation, ‘fatigue‘, ‘decreased interest in sex’, and ‘difficulty becoming sexually aroused’ had the highest prevalence of 81%, 69% and 68%, with a burden of 2.7, 2.4 and 2.3, respectively. ‘Fatigue’ somewhat improved after dialysis initiation, whereas the prevalence and burden of sexual symptoms further increased.

‘We hope these results could help inform older patients with kidney failure who decide to start dialysis on what to expect regarding the development of their symptom burden,’ said Dr. de Rooij.

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