Physical symptoms and quality of life in patients on chronic dialysis: results of The Netherlands Cooperative Study on Adequacy of Dialysis (NECOSAD)

Background. So far, little attention has been paid to the value of dialysis adequacy for patients' quality of life (QL). Therefore we studied the impa ct of demographic, clinical, and dialysis characteristics on physical sympt oms and perceived QL. Methods. The study population consisted of 120 incident chronic haemodialys is (HD) and 106 peritoneal dialysis (PD) patients, starting dialysis treatm ent in 13 Dutch centres. Data were collected 3 months after the start of di alysis. Nine physical symptoms were assessed with a self-administered quest ionnaire. Patient's self-assessment of QL was measured with the 36-item MOS Short Form (SF-36(TM)). Results. The most common symptoms in HD and PD were fatigue (respectively 8 2 and 87%) and itching (73 and 68%). In HD only a medium to high comorbidit y-age risk index was associated with greater symptom burden. In PD also a l ower percentage lean body mass, a lower rGFR, and past episodes of underhyd ration were associated with greater symptom burden. The explained variance by these variables was only 12% in HD and 21% in PD. However, greater sympt om burden explained a substantial additional amount of impaired physical an d mental QL on top of demographics and clinical status. Dialysis variables were associated neither with symptoms nor with QL. Conclusion. Symptom burden can be explained to a limited extent by demograp hic and clinical variables and not by dialysis characteristics. Addition of symptom burden to the other variables makes it possible to explain one-thi rd of perceived QL. This underlines the importance of symptom reduction in order to improve patient's QL.