Study examines symptom burden before and after starting dialysis in older adults


  • Older adults with kidney failure in Europe experienced a considerable increase in symptom burden in the year before starting dialysis, which stabilized in the year after dialysis initiation.

Washington, DC (November 10, 2022) — In a study published in CJASN that included older adults with kidney failure, symptoms related to their condition worsened in the year before patients started dialysis but stabilized after dialysis initiation.

For older people with kidney failure, lessening their symptom burden can help to improve their quality of life. By analyzing data from the European Quality (EQUAL) study, an ongoing prospective multicenter study in patients aged 65 years and older with advanced chronic kidney disease, Esther N.M. de Rooij, MD (Leiden University Medical Center, in The Netherlands) and her colleagues investigated the course of total and individual symptom number and burden before and after 456 patients with kidney failure started dialysis. Thirty symptoms were assessed every 3 to 6 months between 2012 and 2021, with scores for symptom number ranging from 0 to30 and for symptom burden ranging from 0 to150 (with higher scores indicating more severity).

“Dialysis initiation may affect individual kidney failure-related symptoms differently. However, the change in symptoms before and after start of dialysis in older patients has not been studied before,” said Dr. de Rooij.

The analysis revealed that in the year before dialysis initiation, symptom number increased +3.6 and symptom burden increased +13.3. In the year after, symptom number decreased -0.9 and burden decreased -5.9. At dialysis initiation, “fatigue”, “decreased interest in sex” and “difficulty becoming sexually aroused” had the highest prevalence of 81%, 69% and 68%, with a burden of 2.7, 2.4 and 2.3, respectively. “Fatigue” somewhat improved after dialysis initiation, whereas the prevalence and burden of sexual symptoms further increased.

“We hope these results could help inform older patients with kidney failure who decide to start dialysis on what to expect regarding the development of their symptom burden,” said Dr. de Rooij.

Additional study authors include Yvette Meuleman, PhD, Johan W. de Fijter, MD, PhD, Kitty J. Jager, MD, PhD, Nicholas C. Chesnaye, PhD, Marie Evans, MD, PhD, Fergus J. Caskey, MD, Claudia Torino, PhD, Gaetana Porto, MSc, Maciej Szymczak, MD, PhD, Christiane Drechsler, MD, PhD, Christoph Wanner, MD, PhD, Friedo W. Dekker, MD, PhD, and Ellen K. Hoogeveen, MD, PhD.

Disclosures: The authors reported no financial disclosures related to this research.

The article, titled “Symptom Burden before and after Dialysis Initiation in Older Patients,” will appear online at on November 10, 2022, doi: 10.2215/CJN.09190822.

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