Chang Yaxin, Wang Ke, Liu Mengjia, Zhang Zhifang, Ma Huiwen, Gao Xinping, Yang Zhaoxia
Shandong First Medical University, Jinan, China.
The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China.
Ren Fail. 2025 Dec;47(1):2449203. doi: 10.1080/0886022X.2024.2449203. Epub 2025 Jan 13.
To explore the symptom clusters of patients undergoing maintenance hemodialysis and construct a symptom network to identify the core symptoms and core symptom clusters, to provide reference for precise symptom management.
Conveniently selected 354 patients with maintenance hemodialysis were surveyed cross-sectionally using the general information questionnaire, the Dialysis Symptom Index and the Kidney Disease Questionnaire. Symptom clusters were extracted using exploratory factor analysis, and core symptom clusters were identified using hierarchical regression and network analysis.
The most common and severe symptoms were fatigue, dry skin and itching, and the most distressing symptoms were fatigue, itching and trouble falling asleep. Within the symptom network, worry ( = 1.0) had the highest strength, trouble staying asleep( = 0.01) had the highest closeness, and fatigue had the highest betweenness ( = 30) and bridge strength ( = 0.53). A total of four symptom clusters were extracted, namely psychological symptom cluster, sleep disorder symptom cluster, uremia-related symptom cluster, and neurological symptom cluster. Hierarchical regression results showed that the psychological symptom cluster had the greatest impact on patients' quality of life.
Fatigue was the most severe symptom and the bridge symptom, the uremia-related symptom cluster caused the greatest distress for patients, worry was the core symptom, and the psychological symptom cluster was identified as the core cluster. Clinical staff can provide effective symptom management and improve patient symptom burden by establishing intervention strategies centered on these results.
探讨维持性血液透析患者的症状群，构建症状网络以识别核心症状和核心症状群，为精准症状管理提供参考。
便利选取354例维持性血液透析患者，采用一般资料问卷、透析症状指数和肾脏病问卷进行横断面调查。运用探索性因子分析提取症状群，采用分层回归和网络分析识别核心症状群。
最常见且严重的症状为疲劳、皮肤干燥瘙痒，最困扰的症状为疲劳、瘙痒和入睡困难。在症状网络中，担忧（=1.0）强度最高，睡眠维持困难（=0.01）接近度最高，疲劳中介中心性最高（=30）且桥梁强度最高（=0.53）。共提取出四个症状群，即心理症状群、睡眠障碍症状群、尿毒症相关症状群和神经症状群。分层回归结果显示，心理症状群对患者生活质量影响最大。
疲劳是最严重的症状和桥梁症状，尿毒症相关症状群给患者带来最大困扰，担忧是核心症状，心理症状群被确定为核心症状群。临床工作人员可依据这些结果制定干预策略，有效管理症状，减轻患者症状负担。
