Prevalence and Persistence of Uremic Symptoms in Incident Dialysis Patients

Background and objectives. Uremic symptoms are major contributors to the poor quality of life among dialysis patients, but whether their prevalence or intensity has changed over time is unknown. Methods. We examined responses to validated questionnaires in two incident dialysis cohort studies, the Choices for Health Outcomes in Caring for ESRD study (CHOICE; N=926, 1995-1998) and the Longitudinal US/Canada Incident Dialysis study (LUCID; N=428, 2011-2017). We determined the prevalence and severity of uremic symptoms-anorexia, nausea/vomiting, pruritus, sleepiness, difficulty concentrating, fatigue, and pain-in both cohorts. Results. In CHOICE and LUCID, respectively, mean age of the participants was 58 years and 60 years, 53% and 60% were male, and 28% and 32% were Black. In both cohorts, 54% of the participants had diabetes. Median time from dialysis initiation to the symptoms questionnaires was 45 days for CHOICE and 77 days for LUCID. Uremic symptom prevalence in CHOICE did not change from baseline to 1-year follow-up and was similar across CHOICE and LUCID. Baseline symptom prevalence in CHOICE and LUCID was as follows: anorexia (44%, 44%), nausea/vomiting (36%, 43%), pruritus (72%, 63%), sleepiness (86%, 68%), difficulty concentrating (55%, 57%), fatigue (89%, 77%), and pain (82%, 79%). In both cohorts, >80% of patients had ≥ 3 symptoms and >50% had ≥ 5 symptoms. The correlation between individual symptoms was low (rho