J HA1,2, A HOFFMAN1, MA BROWN1,2
1Department of Renal Medicine, St George Hospital, Sydney, New South Wales; 2St George & Sutherland Clinical School, UNSW Medicine, Sydney, New South Wales
Aim: To compare the symptom burden of transplant and dialysis patients.
Background: The symptom burden of patients with end stage renal disease has been well documented but little is known about the symptom burden in transplant patients.
Methods: Symptoms in transplant, peritoneal dialysis (PD) and haemodialysis (HD) patients were measured in November 2015 (n=235) and 2016 (n=228) using the Integrated Palliative care Outcomes Scale (IPOS-Renal). It evaluates 17 symptoms reported as slight (1) to overwhelming (4), along with concerns including depression and anxiety. The maximum symptom burden score is 68.
Results: Response rate was 54%: 41% of patients were on hospital HD, 35% transplant [mean eGFR 51 mL/min (SD 19); 9% CKD Stage 4, 3% Stage 5], 13% PD and 11% home HD. Hospital dialysis patients were older (73±12) than PD (69±15), home HD (63±17) and transplant patients (60±11) (p<0.05). The symptom score for PD patients (15.6±8.6) was comparable to hospital HD patients (15.1±9.8) but higher than home HD (12.0±7.0, p<0.05) and transplant patients (9.6±8.0, p<0.05) in both surveys. Although transplant patients reported less pain, lethargy, poor mobility and difficulty sleeping than dialysis patients, 8-15% still reported severe/overwhelming lethargy (15%), pain (10%), poor mobility (9%) and difficulty sleeping (8%). Transplant patients also reported less anxiety than dialysis patients (5% vs. 14%, p<0.01) but comparable levels of depression most of the time at 7%. There was considerable family anxiety (29% of dialysis patients vs. 9% of transplant patients, p<0.01).
Conclusions: The symptom and psychological burden of dialysis, including home HD, is greater than that of transplant patients. However, the symptom burden of transplant patients is still considerable and under recognised.