From the Guidelines
End-stage renal disease (ESRD) is characterized by a multitude of symptoms, including fatigue, pain, poor mood, dry skin, poor sleep, and muscle cramps, with fatigue being the most common and pain being the most severe, as reported in a recent study published in Kidney International in 2023 1.
Common Symptoms of ESRD
The symptoms of ESRD can be categorized into several groups, including:
- Cardiovascular symptoms, such as high blood pressure and chest pain due to pericarditis
- Gastrointestinal symptoms, such as nausea, vomiting, and loss of appetite
- Dermatological symptoms, such as dry skin and pruritus
- Musculoskeletal symptoms, such as muscle cramps and weakness
- Neurological symptoms, such as confusion and difficulty concentrating
Prevalence of Symptoms
According to a study published in the British Journal of Dermatology in 2018, pruritus is a common feature of ESRD, affecting up to 42% of patients on hemodialysis 1. The study also found that dry skin is the most common cutaneous sign in patients on dialysis, although it does not necessarily correlate with pruritus.
Management of Symptoms
The management of ESRD symptoms typically involves dialysis or kidney transplantation, along with medications to manage specific symptoms, such as phosphate binders for high phosphate levels, erythropoietin for anemia, and blood pressure medications. Regular monitoring of kidney function, electrolytes, and other parameters is essential for managing ESRD. The most recent study published in Kidney International in 2023 recommends a comprehensive approach to managing the symptom burden associated with maintenance dialysis, including the use of patient-reported outcome measures to assess the severity of symptoms and guide treatment decisions 1.
From the Research
Symptoms of End-Stage Renal Disease (ESRD)
The symptoms of ESRD can be complex and varied, affecting multiple aspects of a patient's life. Some of the common symptoms and complications associated with ESRD include:
- Hyperkalemia, hypervolemia, metabolic acidosis, anemia, mineral and bone disorders, and protein-calorie malnutrition 2, 3
- Gastrointestinal symptoms 4
- Musculoskeletal and fluid volume symptoms 4
- Neurological symptoms 4
- Irritation of the mucous membranes and skin 4
- Depression 4
- Sleep disturbance 4
- Sexual symptoms 4
- Anemic symptoms 4
Management of Symptoms
The management of these symptoms is crucial to improve the quality of life of patients with ESRD. This can be achieved through:
- Effective and high-quality palliative care 5, 6
- Supportive management, including assessment and control of symptoms 5
- Collaboration between renal and palliative care professionals 6
- Patient-centered care, taking into account the individual's preferences and priorities 6
- Multidisciplinary cross-organisational input to address the complex care needs of patients with ESRD 6
Palliative Care
Palliative care plays a vital role in the management of ESRD, particularly for patients who opt for conservative management or withdraw from dialysis. Palliative care can provide: