[Brussels, Belgium] Kidney Disease: Improving Global Outcomes (KDIGO) is pleased to announce the publication of Managing the Symptom Burden Associated with Maintenance Dialysis in Kidney International. The conference report describes foundational principles for dialysis care as well as priority research areas based on proceedings at the Symptom-Based Complications in Dialysis Controversies Conference in May 2022. The conference was held in Berlin, Germany, and was co-chaired by Edwina Brown, MD (Imperial College London, United Kingdom) and Raj Mehrotra, MD (University of Washington, United States). Participants included patients, physicians, behavioral therapists, nurses, pharmacists, and clinical researchers.


“The frequency and burden of symptoms experienced by people on hemodialysis and peritoneal dialysis is increasingly recognized throughout the medical community,” said Dr. Brown. “These wide-ranging symptoms include itching, fatigue, pain, dry skin, poor sleep, muscle cramps, and depression.” The Controversies Conference, the fourth in the KDIGO dialysis series, sought to identify the optimal means for the diagnosis, management, and treatment of symptom burden in patients undergoing dialysis therapy. The core outcomes considered included patient-centered issues, perspectives, values, preferences, and quality of life. Plenary presentation topics included: Symptom Burden in People on Dialysis, Symptom Perception: A Biopsychosocial Perspective. Evidence for Symptom Management, and Patient Perspectives of Symptoms Panel Discussion.


Dr. Brown continued, “Many of these symptoms can be improved with proper assessment and individualized management. We believe that nephrology teams can and should play a major role in helping patients manage symptoms without needing to manage all aspects of care. We recognize that locally existing needs and resources are key factors in initiating symptom assessment and implementing meaningful improvements. Yet even when options for clinical response are limited, clinicians should focus on acknowledging, prioritizing, and managing symptoms that are most important to individual patients.”


Identifying and assessing symptoms should be part of routine clinical practice and can be achieved through several approaches, including by asking open-ended questions or using patient-reported outcome measures (PROMs). “PROMs have been used widely in clinical effectiveness research,” said Dr. Mehrotra. “Some PROMs, such as screening for depression or assessment of health-related quality of life, are used routinely in some parts of the world, and they may enhance the patient–provider relationship, improve communication, and support shared decision-making. However, to optimize the use of PROMs in clinical settings, gaps between practice and evidence must be closed, and the value of their use, given the resources required from both clinicians and patients, must be determined.”


In developing treatments and approaches to improving care for dialysis patients, Dr. Mehrotra emphasized, “Research should engage patients, care partners, families, dialysis clinic personnel, nephrology care team members, trainees, dialysis providers, pharmaceutical companies, and payers at all stages. It is certainly possible to reduce symptoms for people on dialysis, and symptom management should be a top research priority in kidney failure.”


The proof of the conference report is available on the KDIGO website and can also be accessed on the Kidney International website.
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