title: Symptoms in advanced renal disease: a cross-sectional survey of symptom prevalence in stage 5 chronic kidney disease managed without dialysis.
abstract: BACKGROUND
  Numbers of patients with stage 5 chronic kidney disease (CKD) managed conservatively (without dialysis) are increasing steadily but prevalence and severity of symptoms in this population are not yet known.
  
  
  OBJECTIVE
  To describe symptom prevalence, symptom severity, and total symptom burden in patients with stage 5 CKD managed conservatively.
  
  
  METHODS
  A cross-sectional survey of patients with stage 5 CKD managed conservatively, in three U.K. renal units. Symptoms were assessed using the patient-completed Memorial Symptom Assessment Scale Short Form (MSAS-SF), with additional renal symptoms.
  
  
  RESULTS
  Sixty-six patients were recruited (response rate, 62%), with mean age 82 years (standard deviation [SD] +/- 6.6), and mean estimated glomerular filtration rate 11.2 mL/min (SD +/- 2.8). Symptoms reported by more than one third or 33% of patients were (95% confidence intervals shown in parentheses): lack of energy, 76% (66%-84%); pruritus, 74% (65%-82%); drowsiness, 65% (54%-74%); dyspnea, 61% (50%-70%); edema, 58% (47%-66%); pain, 53% (42%-63%); dry mouth, 50% (39%-60%); muscle cramps, 50% (39%-60%); restless legs, 48% (38%-58%); lack of appetite, 47% (37%-58%); poor concentration, 44% (34%-54%); dry skin, 42% (32%-53%); sleep disturbance, 41% (32%-51%); and constipation, 35% (26%-45%). Mean number of symptoms reported on MSAS-SF was 11.58 (SD +/- 5.2), with an additional 2.77 (SD +/- 1.7) renal symptoms. Symptoms were also most severe in the more prevalent symptoms. Pain was an exception, with disproportionately greater severity (32% of all patients reported moderate/severe pain).
  
  
  CONCLUSIONS
  This study demonstrates that patients with stage 5 CKD have considerable symptom control needs, similar to advanced cancer populations, but with different patterns of individual symptoms and severity, particularly pain. Implications for palliative care, hospice, and nephrology services in planning and providing care are discussed.
authors: Department of Palliative Care, Policy and Rehabilitation, Weston Education Centre, King's College London, London, United Kingdom.
authors: Fliss E M
authors: FE
authors: Murtagh
authors: Julia M
authors: JM
authors: Addington-Hall
authors: Polly M
authors: PM
authors: Edmonds
authors: Paul
authors: P
authors: Donohoe
authors: Irene
authors: I
authors: Carey
authors: Karen
authors: K
authors: Jenkins
authors: Irene J
authors: IJ
authors: Higginson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007676:Kidney Failure, Chronic / Q000145:classification* / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D008297:Male; D009369:Neoplasms / Q000503:physiopathology; D010166:Palliative Care; D012720:Severity of Illness Index; D006113:United Kingdom