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