The following is a summary of “Symptom Burden before and after Dialysis Initiation in Older Patients” published in the December 2022 issue of Nephrology by Rooij et al.

Reducing symptoms may be more essential than increasing survival time for older people with renal disease. However, it is unknown how dialysis treatment would influence the variety of symptoms associated with renal failure because no research had compared symptoms before and after treatment began. So, researchers looked into how the frequency and severity of symptoms changed before and after beginning dialysis in the elderly. Patients younger than 65 years old with an incident eGFR of ≤20 ml/min per 1.73 m2 are the focus of the ongoing prospective multicenter European Quality (EQUAL) trial.

Over the course of 6 to 12-month intervals between 2012 and 2021, 30 symptoms were evaluated using the dialysis symptom index (DSI). A higher score indicates a more severe case, with the range for symptom burden going from 0 to 150 and the range for symptom number from 0 to 30. In this study, investigators analyzed symptoms in the year before and the year after starting dialysis using mixed effects models. The study group included 456 incident dialysis patients who completed at least one DSI 12 months before or after dialysis. The average (SD) age of those starting dialysis was 76 years, 75% were men, and the average (SD) eGFR was 8 (3)ml/min per 1.73 m2, 44% had diabetes, and 46% had cardiovascular disease. The number of symptoms increased by +3.6 (95% CI, +2.5 to +4.6), and the burden of symptoms increased by +13.3 (95% CI, +9.5 to +17.0) in the year leading up to dialysis commencement. Afterward, the number of symptoms improved by -0.9 (95% CI, -3.4 to +1.5), and the burden dropped by -5.9 (95% CI, -14.9 to -3.0) in the subsequent year. 

The most burdensome side effects of starting dialysis were “fatigue,” “decreased interest in sex,” and “difficulty becoming sexually aroused,” with prevalence rates of 81%, 69%, and 68%, respectively, with a burden of 2.7, 2.4, and 2.3, respectively.  However, the prevalence and burden of sexual symptoms increased following dialysis initiation, while “fatigue” improved significantly. The severity of symptoms increased dramatically before starting dialysis and then leveled off once it had begun. Most bothersome were reports of “fatigue,” “decreased desire in sex,” and “difficulty becoming sexually aroused,” with only “fatigue” showing some improvement following the start of dialysis.