Abstract
The
high prevalence of dialysis-related symptoms in maintenance hemodialysis
(MHD) patients severely affect quality of life. Therefore, in this
study, we assessed the dialysis symptom index (DSI) of
MHD patients during the second wave
of COVID-19, which triggered a health crisis, resulting in many cities
in China opting for social isolation. A total of 106 MHD patients from
our center were screened. DSI, sleep quality, and fatigue scales were
investigated separately before and during lockdown. Demographic and
laboratory data of MHD patients were collected. A nomogram was used to
predict high DSI by combining multiple indicators. Additionally,
internal validation was performed to reduce overfitting bias. The mean
age of patients was 56.0 years (SD 13.1). The prevalence and severity of
DSI were significantly higher during
lockdown than pre-lockdown. Notably,
itching, trouble staying asleep, bone or joint pain, muscle cramps,
feeling irritability, difficulty concentrating, headache, constipation,
and feeling nervous were observed (P <0.05).
Multivariate logistic regression analysis identified longer dialysis
vintage, lower albumin level, and lower Kt/V as predictors of high DSI.
Additionally, the nomogram showed good accuracy in estimating high DSI
with a C-index and bootstrap-corrected index of 0.875 and 0.863,
respectively. Moreover, calibration plots showed optimal consistency
with the actual presence of high DSI. We found a higher prevalence of
DSI in MHD patients during the COVID-19 lockdown. Furthermore, patients
with longer dialysis vintage, lower albumin levels and Kt/V had a risk
of developing high DSI. Further studies should identify targeted
therapies for improving the symptom burden of MHD patients.
KEYWORDS :
COVID-19, dialysis system index,
lockdown, nomogram, predictive model
INTRODUCTION
Maintenance hemodialysis (MHD) patients have a high prevalence of
physical and emotional illness-related symptoms1-3. A
high symptom burden is associated with a high mortality risk in MHD
patients4. In a Thai study, 98.7% of MHD patients
reported one or more symptom burdens, with the most common ones being
itchy skin, dryness, muscle ache, dry mouth, muscle cramps, and
insomnia5. A Korean study revealed that 97.4% of all
MHD patients reported one or more symptoms, with fatigue and dry skin
being the most common physical symptoms and worry, tension, and anxiety
as the most common emotional symptoms6. These symptoms
cause distress and affect the overall well-being of patients, leading to
a reduced quality of life, and may increase patient
mortality1,7. Therefore, a symptom study of end-stage
renal disease (ESRD) patients on hemodialysis would contribute to
effective symptom management and maximize patient benefits.
Studies have shown that the isolation and containment of patients with
COVID-19 have far-reaching effects on different groups, including
insomnia, depression, anxiety, and post-traumatic stress disorder
(PTSD)8-11. A study conducted among isolated college
students confirmed the dramatic impact of the
COVID-19 pandemic on their mental
health12. Psychiatric symptoms were strikingly
prevalent: 67.05% reported traumatic stress, 46.55% reported
depressive symptoms, and 34.73% reported anxiety symptoms. In a study
conducted in a Chinese isolation ward with infected
patients13, the
prevalence of generalized anxiety symptoms was 51.3%; depressive
symptoms, 41.2%; and post-traumatic stress symptoms (PTSS)/PTSD
symptoms, 33.6%. A longitudinal study conducted in France revealed the
impact of the pandemic on the mental health status of the French
population14. The study included participants who had
undergone a mental health study in 2014–2019. The results showed that
isolation led to higher psychological stress and that those with poorer
physical health showed more severe anxiety symptoms.
From the beginning of October till the end of November 2022, the
COVID-19 epidemic in Hefei became increasingly severe. An epidemic is
characterized by multi-point distribution, localized aggregation, and
gradual spillover. Therefore, multiple regions of our city were under
lockdown and static management
during this period. With static management, residents cannot leave their
houses and engage in outdoor activities. Concerns about daily life and
disease treatment caused great psychological and physical distress to
MHD patients. However, the dialysis symptom index (DSI) of MHD patients
during the lockdown remains unclear. Therefore, to fully evaluate the
psychological and mental status of MHD patients, we investigated the DSI
of MHD patients during the COVID-19 lockdown period, so as to provide a
reference for the development of comprehensive management programs for
MHD patients.
METHODS