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Abstract: FR-PO420

Exploring the Skin Symptom Cluster in a Prevalent Hemodialysis (HD) Cohort: The Dominance of CKD-Associated Pruritus and the Association with Fatigue

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hull, Katherine Leigh, University of Leicester College of Life Sciences, Leicester, United Kingdom
  • Joshi, Namrata, University of Leicester College of Life Sciences, Leicester, United Kingdom
  • Jennings, Angus C., University of Leicester College of Life Sciences, Leicester, United Kingdom
  • Billany, Roseanne, University of Leicester College of Life Sciences, Leicester, United Kingdom
  • March, Daniel Scott, University of Leicester College of Life Sciences, Leicester, United Kingdom
  • Graham-Brown, Matthew, University of Leicester College of Life Sciences, Leicester, United Kingdom
  • Burton, James, University of Leicester College of Life Sciences, Leicester, United Kingdom
Background

Haemodialysis (HD) patients have a high symptom burden. Dominant symptoms may precipitate or intensify others, generating a symptom cluster: the co-existence of ≥2 symptoms. This work explores the skin symptom cluster (itching, restless legs, skin changes, difficulty in sleeping) in prevalent HD patients.

Methods

We present prospective symptom data (POS-S Renal) from the CYCLE-HD trial (ISRCTN11299707). Spearman’s rank correlations were considered, alongside linear regression (cluster sum score) and proportional odds logistic regression (fatigue sub-score), both adjusted for age, sex, dialysis vintage and BMI.

Results

118 participants provided symptom data. 77 (65.3%) participants reported ≥2 skin cluster symptoms at baseline. There were positive correlations between each symptom in the skin cluster (all coefficients ≥0.36). A one point difference in baseline itch was associated with a 0.87 increase in total skin cluster score at 6-months; these data, as well as relationships with other symptoms in the cluster, are outlined in Table 1. 70 (59.3%) participants reported fatigue alongside ≥2 skin cluster symptoms at baseline. A unit increase in the skin cluster score at baseline was associated with a 16.1% (3.6-30.1%) higher odds of one unit increase in fatigue at 6-months.

Conclusion

Reporting of symptoms from within the skin cluster is common in the HD population. CKD-aP is the predominant symptom in predicting the persistence and exacerbation of the skin cluster. The skin symptom cluster and fatigue often co-exist and are interdependent. This highlights the importance of elucidating symptom clusters in routine care to improve management of intrusive symptoms.

6-month skin symptom cluster score normal linear model
ParameterEstimate95% CIP-value
Intercept1.36(-2.29,5.01)0.4602
BL Itching0.87(0.36,1.39)0.0011
BL Difficulty Sleeping0.66(0.19,1.14)0.0066
BL Restless Legs0.65(0.17,1.12)0.0082
BL Changes in Skin0.43(-0.15,1.01)0.141
Group (ref=Control)-0.07(-1.1,0.95)0.8875
Age--0.6824
Gender (ref=Female)0.69(-0.45,1.83)0.2307
Dialysis Vintage-0.03(-0.23,0.18)0.7853
BMI-0.06(-0.15,0.03)0.1671

Funding

  • Other NIH Support