Dialysis Symptom Index: Patient-reported outcome measures study of dialysis patients in low resource settings in India

BACKGROUND: End-stage renal disease is the final stage of chronic kidney disease, with hemodialysis as the primary treatment in India. Despite its prevalence, limited studies have focused on patient-reported outcomes, such as symptom burden and health-related quality of life. AIM: To evaluate the symptom burden among adult hemodialysis patients and identify factors influencing their outcomes. METHODS: A multi-center, cross-sectional study was conducted among 157 adult hemodialysis patients in Chennai from March 2024 to June 2024. The Dialysis Symptom Index tool was used to assess 30 physical and emotional symptoms. Correlations between symptom severity and clinical parameters, such as hemoglobin levels and urea reduction ratio (URR), were analyzed. RESULTS: Moderate symptoms were reported by 48% of participants, with worry, insomnia, and feeling unwell identified as the most severe. Psychological symptoms significantly correlated with lower hemoglobin levels, while shortness of breath was linked to suboptimal URR values. Approximately 38% of patients had URR < 65%, which was associated with increased symptom burden. CONCLUSION: Hemodialysis patients experience a substantial psychological and sleep-related symptom burden, emphasizing the need for dialysis adequacy and better hemoglobin management. Enhanced strategies addressing these factors could significantly improve patient outcomes.