Frequency, Severity, and Distress
Of Dialysis-Related Symptoms
Reported by Patients on Hemodialysis
Francess Victoria Nelson Danquah
Lani Zimmerman
Pamela M. Diamond
hronic kidney disease (CKD),
C
the ninth leading cause of
death in the U.S., has a high
incidence of morbidity and
mortality, and the related symptoms
and complications create a significant
economic burden (Schoolwerth et al.,
2006). According to the United States
Renal Data System (USRDS) (2009),
as of 2007, more than 638,000 indi-
viduals had end stage renal disease
(ESRD), and more than 111,000 new
patients were diagnosed. The
Medicare ESRD program expendi-
tures exceeded $24 billion in 2007,
Francess Victoria Nelson Danquah, PhD, RN, is
a Clinical Instructor, University of Texas Health
Science Center, Houston School of Nursing, and an
Adult and Gerontological Nurse Practitioner, Houston,
TX. She is a member of ANNA’s Gulf Coast Chapter.
She may be contacted via e-mail at fvnel@aol.com
Lani Zimmerman, PhD, RN, FAAN, is a Professor,
University of Nebraska Medical Center, College of
Nursing, Lincoln, NB.
Pamela M. Diamond, PhD, is an Associate
Professor, University of Texas Health Science Center,
Houston, School of Public Health, Houston, TX.
Janet Meininger, PhD, RN, FAAN, is the Lee and
Joseph D. Jamail Distinguished Professor, University of
Texas Health Science Center, School of Nursing, and a
Professor, University of Texas Health Science Center,
Houston School of Public Health, Houston, TX.
Nancy Bergstrom, PhD, RN, FAAN, is the Theodore
J. and Mary E. Trumble Professor of Aging Research
and Director, Center on Aging, the University of Texas
Health Science Center, Houston School of Nursing,
Houston, TX.
Authors’ Note: This work was generously supported by
the American Nephrology Nurses’ Association Evidence-
Based Practice Grant, 2008; the Sigma Theta Tau
International Zeta Pi Chapter Grant, 2008; the
American Nurses Foundation, 2008; Mary Elizabeth
Carnegie, DPA, MA, RN, FAAN/ANF Scholar
Award; the Marian and Speros Martel Foundation
Scholarship, 2008 and 2009; and the Good
Samaritan Foundation Scholarship 2005 to 2009.
Statement of Disclosure: The authors reported no
actual or potential conflict of interest in relation to this
continuing nursing education article.
Nephrology Nursing Journal November-December 2010
Continuing Nursing
Education
Janet Meininger
Nancy Bergstrom
Copyright 2010 American Nephrology Nurses’ Association
Nelson Danquah, F.V., Zimmerman, L., Diamond, P.M., Meininger, J., & Bergstrom, N.
(2010). Frequency, severity, and distress of dialysis-related symptoms reported by
patients on hemodialysis. Nephrology Nursing Journal, 37(6), 627-639.
The purpose of this study was to determine which symptoms are the most reported, occur
most frequently, have the greatest severity, and cause the most bother for patients on
hemodialysis (HD), and to determine if the symptoms experienced differ between the first
(HD1) and second (HD2) treatments of the week. An observational, comparative design
was used to determine participants’ HD symptoms experienced on HD1 and HD2, and the
effect of the symptom experience on quality of life (QOL). One hundred subjects were
recruited from five dialysis centers. The adapted Dialysis Frequency, Severity, and
Symptom Burden Index (DFSSBI) and the Medical Outcomes Study Short Form 36 (MOS
SF 36) were administered (N = 99) on HD1 and the DFSSBI again on HD2. Data were
analyzed for significance among symptom experience test scores in relation to HD1 and
HD2, QOL, and gender and age. Of 31 symptoms assessed, respondents reported an aver-
age of 9.77 symptoms on HD1 and 7.51 symptoms on HD2. Overall, more symptoms were
reported, and were more frequent, severe, and bothersome on HD1 when the level of meta-
bolic waste is highest. The most reported symptoms included tiredness, dry skin, difficulty
falling asleep, itching, numbness/tingling, difficulty staying asleep, decreased interest in
sex, and bone/joint pain. Females scored consistently higher than males in the four symp-
tom dimensions. Respondents reported about the same as the population norm (50) on the
physical component summary score of the MOS SF 36 and higher than the norm (65.23)
on the mental component summary score. The study found patients on HD experience mul-
tiple symptoms that can be frequent, severe, and bothersome. Interventions should be devel-
oped and tested to reduce symptom bother and improve QOL.
Goal
To provide an overview of symptoms that are reported most often, occur most frequently, have
the greatest severity, and cause the most bother for patients on hemodialysis.
Objectives
1. Identify the symptoms reported by patients with ESRD on HD.
2. Explain how symptom presence, frequency, severity, and bother as reported by patients on
HD can affect their quality of life.
3. Discuss the findings of the study and their importance to this patient population.
4. Describe how nephrology nurses and other health care providers may use these data to pro-
vide improved care to patients on HD.
This offering for 1.3 contact hours is provided by the American Nephrology Nurses’
Association (ANNA).
ANNA is accredited as a provider of continuing nursing education (CNE) by the American
Nurses Credentialing Center’s Commission on Accreditation.
ANNA is a provider approved by the California Board of Registered Nursing, provider number
CEP 00910.
Accreditation status does not imply endorsement by ANNA or ANCC of any commercial product.
This CNE article meets the Nephrology Nursing Certification Commission’s (NNCC’s) continu-
ing nursing education requirements for certification and recertification.
Vol. 37, No. 6 627