Journal of Pain and Symptom Management
Volume 39, Issue 2 , Pages 211-218, February 2010

Undertreatment of Symptoms in Patients on Maintenance Hemodialysis

  • René N. Claxton, MD

      Affiliations

    • Division of Palliative Care & Ethics, Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
    • Corresponding Author InformationAddress correspondence to: René N. Claxton, MD, Department of Internal Medicine, University of Pittsburgh School of Medicine, 200 Lothrop Street, MUH G-100, Pittsburgh, PA 15213, USA.
    • ,
  • Leslie Blackhall, MD

      Affiliations

    • Division of General Medicine, Geriatrics and Palliative Care, Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
    • ,
  • Steven D. Weisbord, MD

      Affiliations

    • Division of Nephrology, Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
    • VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
    • ,
  • Jean L. Holley, MD

      Affiliations

    • Division of Nephrology, Department of Internal Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA

Accepted 13 July 2009. published online 07 December 2009.

Abstract 

Context

Hemodialysis patients suffer a large symptom burden, and little is known about how effectively symptoms are treated.

Objectives

To assess the management of treatable symptoms in hemodialysis patients, we administered a 30-item questionnaire on physical and emotional symptoms to patients receiving outpatient hemodialysis at the University of Virginia.

Methods

We asked patients whether they were prescribed therapy for potentially treatable symptoms and assessed who prescribed the therapy. By means of chart review, we also documented whether medications were prescribed for these symptoms.

Results

We approached 87 patients and enrolled 62 (71%). The most commonly reported, potentially treatable symptoms included bone/joint pain, insomnia, mood disturbance, sexual dysfunction, paresthesia, and nausea. Only 45% of patients with bone/joint pain reported receiving an analgesic medication. Twenty-three percent of patients with trouble falling asleep and 53% of patients with nausea reported receiving a medication to alleviate this symptom. Chart review revealed that 58% of patients who reported the presence of bone/joint pain were prescribed an analgesic, 23% of patients with trouble falling asleep were prescribed a sleep aid, and 42% of patients with nausea received an antiemetic. Primary care providers were more likely than nephrologists to provide for all symptoms except nausea and numbness or tingling in the feet, and this difference was significant for the treatment of worrying (3/3 vs. 0/3, P=0.05) and nervousness (4/5 vs. 0/5, P=0.02).

Conclusion

Potentially treatable symptoms in hemodialysis are undertreated. Pharmacologic therapy, particularly for emotional symptoms, was more commonly prescribed by primary care providers than nephrologists. Additional study of the barriers to symptom treatment and interventions that increase nephrologist and primary care provider symptom management are needed.

Key Words: Dialysis patients, quality of life, symptom burden, symptom management, symptom assessment

 

 Presented in abstract form at the American Society of Nephrology Annual Meeting, November 2007, and presented at the Annual Assembly of the American Academy of Hospice and Palliative Medicine, January 2008.

 The authors declare no competing financial interests.

PII: S0885-3924(09)00842-2

doi:10.1016/j.jpainsymman.2009.07.003

Journal of Pain and Symptom Management
Volume 39, Issue 2 , Pages 211-218, February 2010

Article Tools