Moskovitch Jeremy T, Mount Peter F, Davies Matthew R P
Department of Medicine, The University of Melbourne, Melbourne, Australia.
Nephrology Department, Austin Health, Melbourne, Australia.
J Palliat Care. 2020 Jan;35(1):59-65. doi: 10.1177/0825859719827315. Epub 2019 Feb 13.
To determine the prevalence, severity, and change in symptoms experienced by dialysis patients following the introduction of use of a symptom-reporting questionnaire in nephrology clinic.
This is an observational study of 160 prevalent dialysis patients. Palliative care Outcome Scale symptom (POS-renal) questionnaires modified for patients with end-stage kidney disease were completed at baseline and follow-up (median 3 months), with results available to nephrologists at clinic appointments.
The baseline prevalence of individual symptoms ranged from 15% to 66%. The most common symptoms were lack of energy (66%) and poor mobility (58%). The median number of symptoms was 7/17 (interquartile range [IQR]: 4-10). Forty-nine percent of patients rated at least 1 symptom as severe or overwhelming. At follow-up, the median number of symptoms experienced was unchanged at 7/17 (IQR: 3-10). However, there was considerable flux in symptom severity. On average, individual symptoms that were present at baseline improved in 56% of patients and worsened in 18%; only 26% had stable symptom severity. Individual symptoms newly occurred in 8% to 20% of patients between time points, with 77% of patients experiencing at least 1 new symptom. The percent of patients rating at least 1 symptom as severe or overwhelming was reduced from 49% to 39% ( = .040).
Use of the POS-renal questionnaire identified a high symptom burden. The presence and severity of symptoms changed dramatically over a short follow-up period, highlighting the need for regular surveillance of symptoms in the dialysis population. Routine use of a symptom questionnaire in clinic may be useful for the identification and management of symptoms in dialysis patients.
为了确定肾病门诊引入症状报告问卷后透析患者所经历症状的患病率、严重程度及变化情况。
这是一项对160例维持性透析患者的观察性研究。为终末期肾病患者修改的姑息治疗结果量表症状（POS-肾）问卷在基线和随访时（中位时间3个月）完成，结果可供肾病科医生在门诊预约时使用。
个体症状的基线患病率在15%至66%之间。最常见的症状是精力不足（66%）和活动能力差（58%）。症状的中位数为7/17（四分位间距[IQR]：4-10）。49%的患者将至少1种症状评为严重或难以承受。随访时，经历的症状中位数保持不变，为7/17（IQR：3-10）。然而，症状严重程度有相当大的波动。平均而言，基线时存在的个体症状在56%的患者中有所改善，在18%的患者中恶化；只有26%的患者症状严重程度稳定。在两个时间点之间，8%至20%的患者出现了新的个体症状，77%的患者至少经历了1种新症状。将至少1种症状评为严重或难以承受的患者比例从49%降至39%（P = .040）。
使用POS-肾问卷发现症状负担较高。在短时间的随访期内，症状的存在和严重程度发生了显著变化，突出了对透析人群症状进行定期监测的必要性。在门诊常规使用症状问卷可能有助于识别和管理透析患者的症状。
