Patient-reported intra-dialytic symptoms and post-dialysis recovery times are influenced by psychological distress rather than dialysis prescription

Abstract

Background: Dialysis is a life-sustaining treatment, but many patients suffer symptoms during dialysis and take time to recover. Previous reports have linked recovery time to intra-dialytic hypotension and rapid solute clearances, whereas others have reported an association with psychological factors. As such, we wished to investigate which factors were important in determining symptom self-reporting and delayed recovery times. Methods: We recorded self-reported patient intra-dialytic symptoms, recovery times along with sessional dialysis prescriptions, blood pressure and urea clearance, and distress thermometer scores to assess psychological factors. Findings: Six hundred twenty-Three dialysis patients were studied; 621 treated by haemodiafiltration, 60.8% male, mean age 64.5 ± 16.2 years, and 46.1% diabetic. Almost half (49.6%) reported recovery within 1 h. On multivariate analysis, patient self-reported symptom scores were associated with longer post-dialysis recovery times (odds ratio (OR) 1.61, 95% confidence limits (CL) 1.33-1.95), higher distress thermometer scores (OR 1.3 CL (1.3-1.39), but lower hand grip strength (OR 0.85 CL (0.93-0.94), all p < 0.001, and younger rather than older patients (OR 0.98 CL (0.97-0.99) p = 0.005. We found no association with ultrafiltration rates or weight loss. Discussion: Compared to earlier studies, our patients treated by haemodiafiltration reported fewer symptoms and shorter recovery times. Patients with higher self-reported distress thermometer scores had both longer post-dialysis recovery times and greater dialysis symptom scores. Younger patients reported more dialysis symptoms and longer recovery times than older patients. Future studies investigating patient self-reported recovery times and dialysis-Associated symptoms should also consider interventions to reduce patient psychological factors as well as dialysis practices.