From the Guidelines
The most common symptoms of failing hemodialysis (HD) include fatigue, pain, poor mood, dry skin, poor sleep, and muscle cramps, with fatigue being the most common and pain being the most severe 1. These symptoms can significantly impact the patient's quality of life and morbidity. Some key points to consider when evaluating these symptoms include:
- The exact incidence and prevalence of individual symptoms vary depending on patient population studied, such as age, comorbidities, sex and gender, frailty, psychosocial concerns, etc. 1
- Development of dialysis-related complications, such as intradialytic hypotension and/or cramps, can also adversely affect the delivered dose of hemodialysis and patient outcomes 1
- Patient nonadherence, including missing hemodialysis sessions or terminating sessions prematurely, can further compromise hemodialysis adequacy 1 It is essential to promptly identify and address these symptoms to minimize their impact on patient outcomes and quality of life. Regular assessments and interventions by the dialysis care team can help determine the cause(s) of these symptoms and plan appropriate corrective actions. By prioritizing the management of these symptoms, healthcare providers can improve patient outcomes and reduce morbidity and mortality associated with failing HD.
From the Research
Common Symptoms of Failing Hemodialysis (HD)
- Fatigue is a highly prevalent condition among HD patients, with consequent poor health-related quality of life and lower survival rates 2
- The complexity of fatigue's pathogenesis and the lack of measurement tools make the development of nursing interventions and practices specifically targeted at its recognition and therapy difficult 2
- Other symptoms that may be associated with failing HD include:
- Anemia, which can be treated with erythropoiesis-stimulating agents (ESAs) 3, 4, 5, 6
- Hyporesponsiveness to ESAs, which can be a problem in dialysis patients 4
- Cardiovascular events, such as myocardial infarction and stroke, which may be associated with ESA therapy 5, 6
- Breathlessness, which may be a symptom of anemia or other complications of HD 6
Factors Associated with Fatigue in HD Patients
- Age, dialysis vintage, inter-dialysis weight gain, and ultra-filtration rate are proportionally related to reported levels of fatigue 2
- Hemoglobin, iron, ferritin, and number of sleep hours before HD session present a significant inverse correlation to fatigue 2
- Proton pump inhibitors (PPIs) may be associated with hyporesponsiveness to ESAs and anemia in HD patients 4
Treatment of Anemia in HD Patients
- ESAs, such as epoetin alfa, epoetin beta, and darbepoetin alfa, are commonly used to treat anemia in HD patients 3, 4, 5, 6
- The choice of ESA and dose may depend on individual patient characteristics and the etiology of anemia 3, 5, 6
- The use of ESAs may be associated with cardiovascular events and other complications, and the risks and benefits of ESA therapy must be carefully considered 5, 6