A Narrative Review of Management Strategies for Common Symptoms in Advanced CKD

• Type of Material: Article
• Authors: Maureen Metzger, University of Virginia; Emaad M. Abdel-Rahman, University of Virginia; Heather Boykin, University of North Carolina; Mi-Kyung Song, Emory University
• Language: English
• Date: 2021-04-05
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Final Published Version
• Copyright Statement: © 2021 International Society of Nephrology. Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ekir.2021.01.038
• Title of Journal or Parent Work: KIDNEY INTERNATIONAL REPORTS
• Volume: 6
• Issue: 4
• Start Page: 894
• End Page: 904
• Keywords: OLDER-ADULTS; symptoms; HEMODIALYSIS-PATIENTS; palliative care; PAIN MANAGEMENT; RESTLESS LEGS SYNDROME; OBSTRUCTIVE SLEEP-APNEA; quality of life; Science & Technology; Life Sciences & Biomedicine; CHRONIC KIDNEY-DISEASE; QUALITY-OF-LIFE; Urology & Nephrology; symptom management; STAGE RENAL-DISEASE; UREMIC PRURITUS; dialysis; SUPPORTIVE CARE; chronic kidney disease
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management

Abstract

Patients with advanced chronic kidney disease (CKD) experience multiple bothersome symptoms, undermining their quality of life (QOL). With growing attention to the importance of symptom management in advanced CKD, the evidence regarding symptoms is increasing. In this review, we briefly summarize the current evidence of effective pharmacologic and nonpharmacologic interventions to improve symptoms and QOL in patients with advanced CKD, including those on dialysis. We focused on symptoms that are commonly experienced by patients, such as pain, fatigue, sleep disturbances, itching, nausea and vomiting, cognitive impairment, and anxiety and depression. We noted that research in symptom science focused on improving symptom management in CKD is still very limited. In addition to the lack of clinical practice guidelines to address those common symptoms, the major gaps in the current literature include the evidence regarding mechanistic pathways to inform the development of effective symptom management for CKD populations, the evidence to confirm effective pharmacologic interventions in other populations for CKD populations, and research on how to incorporate effective symptom management approaches into clinical care. Although improving mortality remains as an important area in the kidney community, there is an urgent need to focus on improving symptom management to improve QOL in advanced CKD.