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Kidney Week

Abstract: PO0837

Provider Recognition of Patient-Reported Symptoms in Patients on Maintenance Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Wen, Huei Hsun, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Chauhan, Kinsuk, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Nadkarni, Girish N., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Chan, Lili, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background

Patients with ESKD on maintenance HD (HD) experience more symptoms than the general population. In order to enable better symptomatic management, it is critical that providers recognize and document these symptoms; however, recognition by nurses and physicians is unclear.

Methods

We surveyed patients that were receiving in-center HD for ≥30 days, and attended HD three times a week at the Mount Sinai Kidney Center. Patients were surveyed on if they experienced 21 symptoms over the past 24 hours at the end of their treatments for 12 sessions. The treating nurses were surveyed at the end of each iHD treatment to identify if the patient had any of the 21 symptoms. We considered a positive response on any of the 12 surveys as a positive during the study period. Physicians were asked during week three of the study period if the patient had experienced any of the 21 symptoms during the past 4 weeks.

Results

Of the 166 eligible patients, 101 consented to the study, and 97 completed all 12 surveys. The mean age was 56±14 years, 52% were female, and 52% were Black. The most common symptoms reported by the patients were fatigue (61%), cramping (59%), and dry skin (53%) (Figure 1). Nurses under-recognized 17/21 symptoms, mean relative difference of 54±33%. Physicians under recognized 16/21 symptoms, by a mean difference of 23±56%. Symptoms with the largest degree of under-recognition by nurses were dry skin (difference of 51 percentage points) and fatigue (difference of 42 percentage points). Physicians struggled most with recognition of cramping (difference of 39 percentage points) and fatigue (difference of 34 percentage points).

Conclusion

Patient symptoms were generally under-recognized by both dialysis nurses and physicians. While several symptoms such as shortness of breath, nausea, and vomiting were well recognized by nurses and physicians, nurses under-recognized dry skin and fatigue and physicians under-recognized cramping and fatigue.

Figure 1: Number of symptoms reported by patients, nurses, and physicians.

Funding

  • NIDDK Support