Symptom management in people with chronic kidney disease (CKD) attending kidney supportive care (KSC) clinics

Abstract

Aims: To examine the symptom burden experienced by people with CKD attending KSC clinics and current management strategies to remediate this burden.

Background: People with CKD have a high symptom burden which impacts quality of life. The multidisciplinary KSC team aims collectively to address the complexity of multifaceted, inter‐related symptoms.

Methods: Retrospective analysis of 50 consecutive patients attending KSC clinics over a 2‐month period. Symptom burden was rated by patients using the validated renal palliative care outcome scale (iPOS‐renal) and EQ‐5D‐5L tools. Demographics, pathology and additional symptoms or psychosocial issues not identified with these tools (non‐iPOS) and clinician interventions were extracted from the clinical record. Analyses was performed using R.

Results: Median age was 71 years, 80% male and 46% attended alone. Participants averaged 6.5 iPOS symptoms, and management strategies were implemented for an average of 3.75 iPOS symptoms and non‐iPOS issues. 32% of interventions were for psychosocial issues not identified on the iPOS. The most common symptoms identified and addressed in clinic were pain (52%), fatigue (32%), constipation (28%), low mood (26%) and pruritus (13%). The majority reported weakness/lethargy on the iPOS (78%). The median EuroQOL self‐assessment global health ranking score was 60. 32 (64%) patients were prescribed at least one new medication, of which almost half were analgesia (46%); frequently pregabalin and/or paracetamol. Targeted education around symptom self‐management was provided to 28% of patients, 56% included sleep hygiene advice, and 32% received social work interventions including referrals for increased community‐based services.

Conclusions: We highlight the burden of symptoms for this older CKD population and the targeted management strategies, which span a spectrum of specialized skill‐sets and interventional approaches.