Symptom burden in chronic kidney disease; a population based cross sectional study

Sameera Senanayake, Nalika Gunawardena, Paba Palihawadana, Palitha Bandara, Rashan Haniffa, R Karunarathna, Priyantha Kumara

Physical and psychological symptoms are among main manifestations of Chronic Kidney Disease (CKD). This study aimed to assess the symptom burden and self-perceived severity of symptoms among CKD patients living in a district in Sri Lanka. A community based cross-sectional study included a sample of randomly selected 1174 CKD patients from all 19 Medical Officer of Health areas in the district of Anuradhapura. Trained para-medical staff visited the households and administered the locally validated questionnaire to assess the presence and severity of symptoms. The inquiry was on 25 symptoms in a 5 point Likert scale indicating the severity during the previous week. Symptom burden score was constructed by summing each symptom severity score which ranged from 0 to 125. A total of 1118 CKD patients participated with a response rate of 95.2%. The mean age was 58.3 (SD 10.8) years and 62.7% were males. A majority were in CKD stage 4 (58.3%). Bone/joint pain was the most experienced symptom (87.6%; 95%CI 85.6-89.5). Loss of libido was the most severe symptom. The median symptom burden score was 35.0 (IQR 20.0-50.0). Multiple linear regression revealed education up to Advanced Level (β -9.176), CKD stage V (β 3.373), being dialyzed (β 20.944), comorbidities (β 4.241) and being employed (β -9.176) to be significant predictors of symptom burden. Patients in all stages of CKD experience high symptom burden warranting rigorous measures to relieve symptoms and to improve the well-being of CKD patients.