Background
Haemodialysis patients experience significant symptom burden and effects on healthrelated quality of life. Studies have shown increases in fluid overload, hospitalization and
mortality immediately after the long interdialytic interval in thrice weekly in-centre haemodialysis patients, however the relationship between the dialytic interval and patient reported
outcome measures (PROMs) has not been quantified and the extent to which dialysis day of
PROM completion needs to be standardised is unknown.
Methods
Three times a week haemodialysis patients participating in a stepped wedge trial to increase
patient participation in haemodialysis tasks completed PROMs (POS-S Renal symptom
score and EQ-5D-5L) at recruitment, six, 12 and 18 months. Time from the long interdialytic
interval, HD day of the week, and HD days vs non-HD days were included in mixed effects
Linear Regression, estimating severity (none to overwhelming treated as 0 to 4) of 17 symptoms and EQ-5D-5L, adjusting for age, sex, time on HD, control versus intervention and
Charlson Comorbidity Score.
Results
517 patients completed 1659 YHS questionnaires that could be assigned HD day (510 on
Mon/Tue/Sun, 549 on Wed/Thu/Tue, 308 on Fri/Sat/Thu and 269 on non-HD days). With
the exception of restless legs and skin changes, there was no statistically significant change
in symptom severity or EQ-5D-5L with increasing time from the long interdialytic interval.
Patients who responded on non-HD days had higher severity of poor appetite, constipation,
difficulty sleeping, poor mobility and depression (approximately 0.2 severity level), and
lower EQ-5D-5L (-0.06, CI -0.09 to -0.03) compared to HD days.
PLOS ONE
PLOS ONE | https://doi.org/10.1371/journal.pone.0274599 September 27, 2022 1 / 13
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OPEN ACCESS
Citation: Hnynn Si PE, Gair R, Barnes T, Dunn L,
Lee S, Ariss S, et al. (2022) Symptom burden
according to dialysis day of the week in three times
a week haemodialysis patients. PLoS ONE 17(9):
e0274599. https://doi.org/10.1371/journal.
pone.0274599
Editor: Gianpaolo Reboldi, Universita degli Studi di
Perugia, ITALY
Received: August 8, 2021
Accepted: August 31, 2022
Published: September 27, 2022
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication of
all of the content of peer review and author
responses alongside final, published articles. The
editorial history of this article is available here:
https://doi.org/10.1371/journal.pone.0274599
Copyright: © 2022 Hnynn Si et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: A minimal dataset
required to reach the conclusions drawn from this
manuscript required the linkage of identifiable
patient information collected during the trial to
Conclusions
Measuring symptom severity and EQ-5D-5L in haemodialysis populations does not need to
account for dialysis schedule, but completion either on HD or non-HD days could introduce
bias that may impact evaluation of interventions. Researchers should ensure completion of
these instruments are standardized on either dialysis or non-dialysis days.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)