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Kidney Week

Abstract: TH-PO301

Assessing a Modified Edmonton Symptom Assessment System as a Patient Report Outcome Measure for Patients on Dialysis in Canada

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Wu, Juliana, Canadian Institute for Health Information, Toronto, Ontario, Canada
  • Terner, Michael, Canadian Institute for Health Information, Toronto, Ontario, Canada
  • Manno, Michael, Canadian Institute for Health Information, Toronto, Ontario, Canada
  • Chiu, Helen, BC Renal Agency, Vancouver, British Columbia, Canada
  • Djurdjev, Ognjenka, BC Renal Agency, Vancouver, British Columbia, Canada
  • Levin, Adeera, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada

Patients with end-stage renal disease (ESRD) often experience heavy symptom burden that is under-recognized in the absence of routine and systematic assessment and management, resulting in poor quality of life. In Canada, British Columbia has implemented a modified Edmonton Symptom Assessment System (mESAS) to monitor symptom burden in patients with ESRD. Completion of the mESAS was voluntary. Implementation started in 2010 and was staggered across facilities. We investigated whether the mESAS functions as a patient-reported outcome measure (PROM) for patients on dialysis, specifically whether the mESAS is feasible to use in routine assessment and is responsive to changes in patient symptoms over time.


The dataset comprised 3,573 patients from 7 dialysis facilities in British Columbia, 62% of whom had completed at least 1 assessment. Of these, 77% completed more than one assessment that can be used for longitudinal analysis. The dataset included assessments performed between March 2010 and April 2016. We used descriptive statistics to examine mESAS practice and changes in symptom scores over time.


Of the patients with more than 1 mESAS assessment, the majority (69%) of adjacent assessments were completed within a 3 ± 1.5 month timeframe, and an additional 16% were completed within a 6 ± 1.5 month timeframe. For symptoms that were scored within the severe category (between 7 and 10 on the scale), the majority improved to below the severe category in a subsequent assessment. Across years, the proportion of symptom scores in the severe category demonstrated a change to lower scores using the mESAS. The results for improved symptoms scores across centres and years varied between 68 and 93%.


There was sufficient data available for analysis of mESAS scores and changes in scores over time. Serial collection of this data allows a real time opportunity to assess symptom burden at a specific point in time as well as the responsiveness of mESAS over time. There is also important value in collecting PROMs in renal patients to further explore how PROMs can be used to evaluate symptom management strategies and thereby optimize patient quality of life.