2.3 Assessment of dialysis symptom index
The DSI is a validated instrument consisting of 30 questions to assess
the severity of discomfort and unpleasant emotions in patients on MHD,
with each question addressing a specific physical or emotional
symptom7,15. The 30 questions can be summarized into
eight groups of symptoms: 1) gastrointestinal, 2) musculoskeletal and
fluid volume, 3) neurological symptoms, 4) irritation of the mucous
membranes and skin, 5) depression, 6) sleep disturbance, 7) sexual
symptoms, and 8) anemia. Patients were asked to report symptoms that
occurred in the last week, answering “yes” or “no” to each symptom.
Severity was assessed on a five-point Likert scale, with scores ranging
from 0 to 4 for each answer (i.e., a response of ”0” means ”no,” whereas
a response of ”4” means ”yes: very much”). The total DSI score
represents the sum of individual scores (ranging from 0 to 120), with
higher total scores indicating higher overall symptom severity.