Guerraoui Abdallah, Haesebaert Julie, Subtil Fabien, Hanf William, Pelletier Caroline, Jullien Perrine, Villar Emmanuel, Mezaache Sarah, Filancia Anna, Fauvel Jean-Pierre, Mariat Christophe, Granal Maelys, Guebre-Egziabher Fitsum, Couchoud Cecile, Caillette-Beaudoin Agnès, Fouque Denis
Calydial, Centre Hospitalier de Vienne Lucien Hussel, Vienne, France.
Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Villeurbanne, France.
Clin Kidney J. 2025 Jul 30;18(9):sfaf239. doi: 10.1093/ckj/sfaf239. eCollection 2025 Sep.
Patients receiving haemodialysis (HD) experience symptoms that impact quality of life. This study assessed the concordance of symptoms and symptom severity of HD patients and their perception by nurses and nephrologists.
A cross-sectional, observational study using the 30-item Dialysis Symptom Index (DSI) questionnaire was conducted in six dialysis centres in France from 1 March 2022 to 30 June 2023. Patients were interviewed during dialysis sessions. Nurses and nephrologists were asked to complete the DSI questionnaire thereafter, to report patient symptoms they considered present. Responses were compared using sensitivity and the Cohen's κ estimate for an interrater agreement involving presence (yes/no) and intensity (5-point Likert scale).
A total of 256 patients, 123 nurses and 27 nephrologists participated. Patients reported four symptoms as most severe (score >3): restless legs or difficulty keeping still, feeling tired or lack of energy, bone or joint pain and trouble falling asleep. Comparisons showed a sensitivity ≥50% for 1/30 symptoms by nurses and 3/30 by nephrologists. Concordance for the presence of symptoms between nurses-patients and nephrologists-patients was low (κ >0.21-<0.40). Patient-nurse agreement was very low for 14 symptoms (46.6%), low for 15 (50.0%) and moderate for 1 (3.4%). Patient-nephrologist agreement was very low for 21 symptoms (70.0%) and low for 9 (30.0%). Nurse-nephrologist disagreement occurred for three symptoms (10.0%), very low agreement for 25 symptoms (83.3%) and low for 2 symptoms (6.7%).
Nurses and nephrologists underestimate the presence and severity of symptoms perceived by patients. Future systematic assessment of symptoms by patient-reported outcome measures should be considered.
接受血液透析（HD）的患者会出现影响生活质量的症状。本研究评估了HD患者的症状及症状严重程度与护士和肾病专家认知之间的一致性。
2022年3月1日至2023年6月30日，在法国的六个透析中心进行了一项横断面观察性研究，使用包含30个条目的透析症状指数（DSI）问卷。在透析过程中对患者进行访谈。之后要求护士和肾病专家完成DSI问卷，报告他们认为患者存在的症状。使用敏感性和科恩κ系数估计值比较回答情况，以评估关于症状存在（是/否）和严重程度（5级李克特量表）的评分者间一致性。
共有256名患者、123名护士和27名肾病专家参与。患者报告了四种最严重的症状（评分>3）：不安腿或难以保持静止、感到疲倦或缺乏精力、骨或关节疼痛以及入睡困难。比较显示，护士对1/30的症状敏感性≥50%，肾病专家对3/30的症状敏感性≥50%。护士与患者之间以及肾病专家与患者之间在症状存在方面的一致性较低（κ>0.21-<0.40）。患者与护士对14种症状（46.6%）的一致性非常低，对15种症状（50.0%）的一致性低，对1种症状（3.4%）的一致性中等。患者与肾病专家对21种症状（70.0%）的一致性非常低，对9种症状（30.0%）的一致性低。护士与肾病专家对三种症状（10.0%）存在分歧，对25种症状（83.3%）的一致性非常低，对2种症状（6.7%）的一致性低。
护士和肾病专家低估了患者所感知症状的存在和严重程度。未来应考虑通过患者报告结局指标对症状进行系统评估。
