Validation of the IPOS-Renal Symptom Survey in advanced kidney disease; a cross-sectional study

Context:The significant symptom burden in advanced renal disease is often poorly recognized by clinicians. Recently, the Integrated Palliative Outcome Score (IPOS) – Renal survey was developed from pre-existing tools to capture these symptoms and other common concerns. Objectives:We studied the validity and reliability of the IPOS-Renal survey (patient and staff versions) in an Australian population. Methods:Adult patients with advanced renal disease and nurses caring for them participated. We initially administered the IPOS-Renal survey simultaneously with other validated surveys, then re-tested the IPOS-Renal after 7-14 days. We tested the construct validity of (a) IPOS-Renal patient version in relation to the Edmonton Symptom Assessment Survey- revised and the KDQOL-SF v1.3 questionnaire; and (b) IPOS-Renal staff version in relation to the Support Team Assessment Schedule (STAS) survey. Results: 81 patients (65 haemodialysis, 10 peritoneal dialysis and 6 on supportive care; average age 64.9 years) and 53 nurses (average renal nursing experience 10.9 years) participated. Intra-class coefficients for test-retest reliability were >0.7 for most queries; Cronbach’s alpha for internal consistency was 0.84 (patient version) and 0.91 (staff version). In tests of construct validity, Spearman’s coefficient of correlation between surveys and their comparators for similar questions was significant, at 0.61 to 0.77 (patients) and 0.24 to 0.76 (staff). As expected, symptom scores and total symptom burden were negatively correlated with summary scores of quality of life. Conclusion:The IPOS-Renal surveys, patient and staff versions, have good test-retest reliability, internal consistency and construct validity in patients with advanced kidney disease and their nurses. We recommend their use in symptom assessment