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Symptoms in the month before death for stage 5 chronic kidney disease patients managed without dialysis

Symptoms in the month before death for stage 5 chronic kidney disease patients managed without dialysis
Symptoms in the month before death for stage 5 chronic kidney disease patients managed without dialysis
Context: There is little evidence on the symptoms experienced by those with advanced (Stage 5) chronic kidney disease (CKD), managed without dialysis, as they approach death. As palliative care extends to noncancer illnesses, understanding symptom prevalence and severity close to death will clarify which symptom interventions are most needed and which elements of (largely cancer driven) models of palliative care best translate into end-of-life care for this population.

Objectives: To determine symptom prevalence and severity in the last month of life for patients with Stage 5 CKD, managed without dialysis.

Methods: Longitudinal symptom survey in three U.K. renal units, using the patient-completed Memorial Symptom Assessment Scale-Short Form (MSAS-SF). We calculated the prevalence of individual symptoms (with 95% confidence intervals [CI] to reflect sample size), plus MSAS-SF subscales, in the month before death. Comparison is made with previously published data on symptoms in last month of life in advanced cancer, also measured using MSAS-SF.

Results: Seventy-four patients (mean age: 81 years; standard deviation [SD]: 6.8) were recruited (response rate: 73%); 49 (66%) died during follow-up (mean age: 81 years; SD: 5.7). “Month before death” symptom data were available for 43 (88%) of the 49 participants who died. Median time of data collection was 18 days from death (interquartile range: 12–26 days). More than half had lack of energy (86%; 95% CI: 73%–94%), itch (84%; 70%–93%), drowsiness (82%; 68%–91%), dyspnea (80%; 66%–90%), poor concentration (76%; 61%–87%), pain (73%; 59%–85%), poor appetite (71%; 57%–83%), swelling arms/legs (71%; 57%–83%), dry mouth (69%; 55%–82%), constipation (65%; 50%–78%), and nausea (59%; 44%–73%). Levels of distress correspond to prevalence, with the exception of dyspnea, which was disproportionately more distressing. The median number of symptoms reported was 16.6 (range: 6–27), rising to 20.4 (range: 7–34) if additional renal symptoms were included. On average, psychological distress was moderate (mean MSAS-PSYCH: 1.55) but with wide variation (SD: 0.50; range: 0.17–2.40), suggesting diverse levels of individual distress. The prevalence of both physical and psychological symptoms and the number reported were higher than those in advanced cancer patients in the month before death.

Conclusion: Stage 5 CKD patients have clinically important physical and psychological symptom burdens in the last month of life, similar or greater than those in advanced cancer patients. Symptoms must be addressed through routine symptom assessment, appropriate interventions, and with pertinent models of end-of-life care.
symptoms, prevalence study, end of life, noncancer palliative care, chronic kidney disease, end-stage kidney disease
0885-3924
Murtagh, Fliss E.
f530aace-a28a-4c42-a786-fff38ef44aa1
Addington-Hall, Julia
87560cc4-7562-4f9b-b908-81f3b603fdd8
Edmonds, Polly
248129cd-49da-4893-bbe9-aed47ec26055
Donohoe, Paul
686eb609-2555-4f5d-b71a-4588dc5421b8
Carey, Irene
cf3f5457-1fbc-4077-9219-c64a50798595
Jenkins, Karen
015e2f3e-690b-40d1-b30f-324702cc2a31
Higginson, Irene J.
8bff8e06-57f3-491b-ab81-2ecf983f52f3
Murtagh, Fliss E.
f530aace-a28a-4c42-a786-fff38ef44aa1
Addington-Hall, Julia
87560cc4-7562-4f9b-b908-81f3b603fdd8
Edmonds, Polly
248129cd-49da-4893-bbe9-aed47ec26055
Donohoe, Paul
686eb609-2555-4f5d-b71a-4588dc5421b8
Carey, Irene
cf3f5457-1fbc-4077-9219-c64a50798595
Jenkins, Karen
015e2f3e-690b-40d1-b30f-324702cc2a31
Higginson, Irene J.
8bff8e06-57f3-491b-ab81-2ecf983f52f3

Murtagh, Fliss E., Addington-Hall, Julia, Edmonds, Polly, Donohoe, Paul, Carey, Irene, Jenkins, Karen and Higginson, Irene J. (2010) Symptoms in the month before death for stage 5 chronic kidney disease patients managed without dialysis. Journal of Pain and Symptom Management. (doi:10.1016/j.jpainsymman.2010.01.021). (In Press)

Record type: Article

Abstract

Context: There is little evidence on the symptoms experienced by those with advanced (Stage 5) chronic kidney disease (CKD), managed without dialysis, as they approach death. As palliative care extends to noncancer illnesses, understanding symptom prevalence and severity close to death will clarify which symptom interventions are most needed and which elements of (largely cancer driven) models of palliative care best translate into end-of-life care for this population.

Objectives: To determine symptom prevalence and severity in the last month of life for patients with Stage 5 CKD, managed without dialysis.

Methods: Longitudinal symptom survey in three U.K. renal units, using the patient-completed Memorial Symptom Assessment Scale-Short Form (MSAS-SF). We calculated the prevalence of individual symptoms (with 95% confidence intervals [CI] to reflect sample size), plus MSAS-SF subscales, in the month before death. Comparison is made with previously published data on symptoms in last month of life in advanced cancer, also measured using MSAS-SF.

Results: Seventy-four patients (mean age: 81 years; standard deviation [SD]: 6.8) were recruited (response rate: 73%); 49 (66%) died during follow-up (mean age: 81 years; SD: 5.7). “Month before death” symptom data were available for 43 (88%) of the 49 participants who died. Median time of data collection was 18 days from death (interquartile range: 12–26 days). More than half had lack of energy (86%; 95% CI: 73%–94%), itch (84%; 70%–93%), drowsiness (82%; 68%–91%), dyspnea (80%; 66%–90%), poor concentration (76%; 61%–87%), pain (73%; 59%–85%), poor appetite (71%; 57%–83%), swelling arms/legs (71%; 57%–83%), dry mouth (69%; 55%–82%), constipation (65%; 50%–78%), and nausea (59%; 44%–73%). Levels of distress correspond to prevalence, with the exception of dyspnea, which was disproportionately more distressing. The median number of symptoms reported was 16.6 (range: 6–27), rising to 20.4 (range: 7–34) if additional renal symptoms were included. On average, psychological distress was moderate (mean MSAS-PSYCH: 1.55) but with wide variation (SD: 0.50; range: 0.17–2.40), suggesting diverse levels of individual distress. The prevalence of both physical and psychological symptoms and the number reported were higher than those in advanced cancer patients in the month before death.

Conclusion: Stage 5 CKD patients have clinically important physical and psychological symptom burdens in the last month of life, similar or greater than those in advanced cancer patients. Symptoms must be addressed through routine symptom assessment, appropriate interventions, and with pertinent models of end-of-life care.

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More information

Accepted/In Press date: 2010
Keywords: symptoms, prevalence study, end of life, noncancer palliative care, chronic kidney disease, end-stage kidney disease

Identifiers

Local EPrints ID: 162809
URI: http://eprints.soton.ac.uk/id/eprint/162809
ISSN: 0885-3924
PURE UUID: 40228732-94bc-4d8c-98b1-eb93c00aedb3

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Date deposited: 31 Aug 2010 08:21
Last modified: 14 Mar 2024 02:03

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Contributors

Author: Fliss E. Murtagh
Author: Polly Edmonds
Author: Paul Donohoe
Author: Irene Carey
Author: Karen Jenkins
Author: Irene J. Higginson

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