Symptom Clusters and Influencing Factors in Elderly Patients on Maintenance Hemodialysis

Abstract

AbstractBackground Symptom clusters can provide empirical evidence for the development of personalized and accurate symptom management strategies. This study aimed to investigate symptom clusters in elderly patients on maintenance hemodialysis, and to explore factors influencing symptom clusters. Methods We conducted a cross-sectional study at the Huashan Hospital Hemodialysis Center. A total of 171 maintenance hemodialysis patients were enrolled. We noted demographic characteristics and collected biochemical indicators. Symptom presence and distress ratings were assessed using the Dialysis Symptom Index (DSI). Factor analyses and latent profile analyses were used, respectively, to explore symptom clusters and differing levels of distress. Binary logistic regression was used to explore risk factors associated with differing levels of distress in symptom clusters. Results The mean (± SD) age of participants in our cohort was 69.10±8.06 years, and 57.9% of patients were male. Six symptom clusters were obtained from our exploratory factor analysis, including a “mental emotional symptom cluster”, a “dialysis insufficiency symptom cluster”, a “neuromuscular symptom cluster”, a “pulmonary-intestinal symptom cluster”, a “vegetative nerve dysfunction symptom cluster”, and a “sexual function symptom cluster”. A three-class solution demonstrated the best fit [low distress class (71.9%), moderate distress class (20.5%), and high-distress class (7.6%)]. Female sex (OR: 3.503; 95%CI:1.424, 8.617), cardiovascular disease history (OR: 3.566; 95%CI:1.470, 8.651), low BMI (OR: 2.965; 95%CI: 1.239, 7.093), high iPTH (OR: 5.559; 95%CI: 1.096, 28.207), and highβ2microglobulin (OR: 2.485; 95%CI: 1.034, 5.974) significantly predicted moderate & high-distress profiles of symptom clusters compared to the low distress profile. Conclusion We identified six symptom clusters, and three different levels of distress amongst those clusters, in elderly patients receiving maintenance hemodialysis. Identifying risk factors for higher symptom cluster distress profiles could help formulate accurate and effective symptom management strategies.