BACKGROUND/RATIONALE:
There are currently over 500,000 individuals with end-stage renal disease in the United States, and more than 100,000 new patients develop this condition annually. Recent estimates suggest that more than 35,000 Veterans currently receive chronic hemodialysis. Although life-sustaining, hemodialysis is associated with substantial morbidity and mortality. With the recognition that providers have limited means beyond renal transplantation to prolong the lives of patients on hemodialysis, investigators are refocusing their research efforts on identifying interventions to improve patients' quality of life, which is substantially impaired in this population. Several major factors that contribute to poor quality of life have been identified, including the large burden of physical and emotional symptoms in this patient population. Of the many symptoms that affect patients on hemodialysis, pain, sexual dysfunction, and depression are among the most prevalent, severe, and highly correlated with impaired quality of life. These observations are particularly noteworthy with data documenting the safety and efficacy of pharmacologic therapy for these symptoms. Nonetheless, preliminary studies suggest that even when severe, these symptoms are untreated or under-treated in patients on hemodialysis. Therefore, efforts to identify and implement strategies to improve the management of pain, sexual dysfunction and depression in the hemodialysis population are needed.

OBJECTIVE(S):
The broad objective of this 3-year project was to determine the most effective strategy for the management of pain, sexual dysfunction, and depression in patients on chronic hemodialysis. In a randomized clinical trial of 245 patients receiving hemodialysis at 9 dialysis units, we compared two symptom management strategies: (a) providing feedback on patients' symptoms to renal providers along with evidence-based algorithms for their treatment and; (b) using renal symptom management nurses to identify and facilitate treatment of these symptoms. We hypothesized that having trained symptom management nurses facilitate the management of pain, sexual dysfunction,, and depression would result in greater improvement in these symptoms than a strategy of simply providing feedback on these symptoms to renal providers.

METHODS:
After enrollment, baseline data was collected from all patients during an observation period of 2 to 12 months. Pain, sexual dysfunction, depression were assessed monthly. Quality of life, overall symptom burden and satisfaction with care were assessed quarterly during this observation period.After the observational phase, patients were randomized into one of two study arms. One group was randomized to a "feedback intervention" in which renal providers received data on the presence and severity of patients' pain, sexual dysfunction, and depression along with algorithms for the treatment of these symptoms. Treatment decisions were left at the discretion of the provider(s). The other group was randomized to a "management intervention" in which renal symptom management nurses assessed these symptoms and facilitated the implementation of treatment for pain, sexual dysfunction, and depression.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
By determining the most effective approach to the management of overall pain, sexual dysfunction, and depression, we hope to introduce a patient-centered management approach to improve the symptom burden and quality of life of Veterans receiving chronic hemodialysis. We also aim to determine which patients on chronic hemodialysis are most amenable to and likley to respond to more aggressive management of these three symptoms.

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External Links for this Project

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PUBLICATIONS:

None at this time.

DRA: Mental, Cognitive and Behavioral Disorders, Health Systems Science, Kidney Disorders
DRE: Etiology, Treatment - Observational, Treatment - Comparative Effectiveness
Keywords: none
MeSH Terms: none