Clinical Assessment of Dialysis Recovery Time and Symptom Burden: Impact of Switching Hemodialysis Therapy Mode

Stephanie Bolton,1 Rachel Gair,2 Lars-Göran Nilsson,3 Michael Matthews,1 Louanne Stewart,1 Natasha McCullagh1 1Renal Unit, Antrim Area Hospital, Northern Health and Social Care Trust, Northern Ireland, UK; 2UK Renal Registry, Bristol, UK; 3Baxter International Inc., Lund, SwedenCorrespondence: Stephanie BoltonRenal Unit, Antrim Area Hospital, Northern Health and Social Care Trust, Northern Ireland, UKEmail Stephanie.Bolton@northerntrust.hscni.netIntroduction: Most people on hemodialysis (HD) report a high symptom burden. Fatigue and lack of energy are prominent, interfering with daily life and associated with poor outcome. Prolonged recovery time after each of the thrice weekly dialysis treatments is common. The impact of HD therapies, like expanded hemodialysis (HDx), on patient reported recovery time and symptom burden is unclear.Methods: A dialysis unit decided to perform regular assessments of patient-reported symptom burden, using the POS-S Renal Symptom questionnaire and the “Recovery time from last dialysis session” question as part of routine patient focused care. At a similar time, a clinical evidence-based decision was taken to switch the in-center dialysis cohort from regular high-flux dialysis membrane to medium cut-off (MCO) membrane, introducing HDx therapy.Results: Quarterly assessment of patient-reported symptom burden was well accepted. A sustained clinically relevant reduction in post-dialysis recovery time was observed following the therapy switch. In patients providing data up to 12 months (N = 58), median recovery time decreased from 210 min (IQR 7.5– 600) to 60 min (0– 210; p = 0.002) and 105 min (0– 180; p = 0.001) at 6 and 12 months, respectively. Thirty-six percent of individuals reported a recovery time longer than 360 minutes at the initial assessment, which decreased to 9% at 12 months. The POS-S Renal total symptom score showed a decrease at 6 months but no difference from baseline at 12 months. The “fatigue/lack of energy” symptom showed a sustained improvement; the percentage of participants scoring its impact as “severe” or “overwhelming” decreased from 28% at baseline to 16% at 12 months. Changes in other symptoms were more variable.Conclusion: Regular assessment of patient reported symptoms is feasible in routine dialysis practice and can help in evaluating the impact of clinical interventions. Observations suggest that HDx therapy may reduce post-dialysis recovery time and improve perceived fatigue level.Keywords: post-dialysis recovery time, symptom burden, fatigue, HDx therap