Cox Kim J, Parshall Mark B, Hernandez Stephen H A, Parvez Sanah Z, Unruh Mark L
College of Nursing.
Division of Nephrology, Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA.
Hemodial Int. 2017 Oct;21(4):524-533. doi: 10.1111/hdi.12521. Epub 2016 Dec 19.
Assessment of dialysis-related symptoms is not currently a requirement for hemodialysis (HD) providers in the United States. The purpose of this study was to describe patients' perspectives on symptoms associated with end-stage chronic kidney disease treated with thrice-weekly, in-center HD.
We performed a qualitative study using interpretive description. Interview questions were based on a KDIGO (Kidney Disease Improving Global Outcomes) controversies conference and a literature review. Semi-structured interviews were analyzed for characterizations of symptoms.
Fifty participants (48% female; 42% Hispanic; 30% American Indian; 14% Black; 12% non-Hispanic White) were recruited from six outpatient dialysis centers (four urban, two rural) in the southwestern United States. Median HD duration was 4 years. Of 13 symptoms assessed, nearly all participants reported difficulties with muscle cramping, fatigue, or both. Negotiating fluid removal with dialysis personnel helped to manage cramping. Some participants tried to adjust dialysis days and shift to mitigate fatigue. Most participants reported having experienced depression early in the course of dialysis; for some, it was a persistent or recurrent problem. Relatively few participants reported using antidepressants or counseling to cope with depression. Itching was highly distressing for those who experienced it frequently. Topical treatments, antihistamines, dietary modifications, and phosphate binders were identified as potentially helpful by some participants.
The major symptoms attributed to HD treatment by participants were cramping, fatigue, depression, and itching. Greater attention by health care providers to the most common and bothersome symptoms could positively impact daily life for HD patients.
目前，美国血液透析（HD）服务提供者无需评估与透析相关的症状。本研究旨在描述患者对每周三次中心HD治疗的终末期慢性肾病相关症状的看法。
我们采用解释性描述进行了一项定性研究。访谈问题基于KDIGO（改善全球肾脏病预后组织）争议会议及文献综述。对半结构化访谈进行分析以确定症状特征。
从美国西南部的六个门诊透析中心（四个城市中心，两个农村中心）招募了50名参与者（48%为女性；42%为西班牙裔；30%为美国印第安人；14%为黑人；12%为非西班牙裔白人）。HD中位治疗时间为4年。在评估的13种症状中，几乎所有参与者都报告有肌肉痉挛、疲劳或两者皆有的问题。与透析人员协商液体清除有助于控制痉挛。一些参与者试图调整透析天数和班次以减轻疲劳。大多数参与者报告在透析过程早期经历过抑郁；对一些人来说，这是一个持续或反复出现的问题。相对较少的参与者报告使用抗抑郁药或咨询来应对抑郁。瘙痒对频繁经历的人来说非常痛苦。一些参与者认为局部治疗、抗组胺药、饮食调整和磷结合剂可能有帮助。
参与者认为HD治疗的主要症状是痉挛、疲劳、抑郁和瘙痒。医疗保健提供者更多地关注最常见和最困扰的症状可能会对HD患者的日常生活产生积极影响。
