Symptom experience in non-dialysis-dependent chronic kidney disease: a qualitative descriptive study

A study published by Pugh-Clarke KRead SCSim J in the Journal of Renal Care in December 2017 suggests that patients with CKD stages 4 and 5 may have a high symptom burden. Whilst symptom burden in patients with advanced CKD managed without dialysis has been likened to that of palliative care cancer populations, there is little information about the nature and range of symptoms in earlier stages of the CKD trajectory.

The above-mentioned paper reports the findings of the preliminary phase of a study aimed at exploring the symptom experience in patients with CKD stages 4 and 5. Symptoms attributable to impaired kidney function are important determinants of quality of life and functional status in patients with chronic kidney disease (CKD). As a result, it is considered that symptom assessment and subsequent control are prerequisites of high-quality care in this patient population.

How was the study done?
Eighteen semi-structured patient interviews were conducted, using an interview schedule developed specifically to guide discussion. Data were analysed using thematic analysis to identify symptom categories and thematic patterns across the patient experiences.

Patients reported a wide range of symptoms, with over 50 different categories and sub-categories emerging from the interview data. Symptom categories could be broadly classified into physical symptoms, such as ‘Altered taste perception’, ‘Sleep disturbance’ and ‘Fatigue’, and psychological symptoms, such as ‘Forgetfulness’, ‘Poor concentration’ and ‘A sensation of gradually slowing down’.

It is interesting to note that when questioned further, patients indicated that they would not usually report their symptoms to clinicians. This emphasises a need for clinicians to incorporate symptom assessment into routine clinical consultations.