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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Dialysis Symptom Index: Patient-reported outcome measures study of dialysis patients in low resource settings in India
Anuradha Pichumani, Pichumani Kodaganallur Parthasarathi, Nagarajan Mani, Sriram Damal Kandadai, Deepalaxmi Rathakrishnan, Murali Krishna Moka, Latha Sundar, Melvin George
Anuradha Pichumani, Department of Obstetrics and Gynaecology, Sree Renga Hospital, Chennai 603001, Tamil Nadu, India
Pichumani Kodaganallur Parthasarathi, Department of Family Medicine/Diabetology, Sree Renga Hospital, Chennai 603001, Tamil Nadu, India
Nagarajan Mani, Department of Nephrology, Government Chengalpattu Medical College and Hospital, Chengalpattu 603001, Tamil Nadu, India
Sriram Damal Kandadai, Department of Diabetology and Endocrinology, Hindu Mission Hospital, Chennai 600045, Tamil Nadu, India
Deepalaxmi Rathakrishnan, Murali Krishna Moka, Melvin George, Department of Clinical Research, Hindu Mission Hospital, Chennai 600045, Tamil Nadu, India
Latha Sundar, Department of Critical Care, Hariharan Diabetes and Heart Care Hospitals Pvt. Ltd, Chengalpattu 600061, Tamil Nadu, India
Co-first authors: Anuradha Pichumani and Pichumani Kodaganallur Parthasarathi.
Author contributions: Pichumani A and Kodaganallur Parthasarathi P contributed to conceptualization, methodology, original draft writing, and supervision of the study, were involved in investigation, data curation, and writing and editing the manuscript as the co-first authors of the paper; Mani N performed formal analysis, validation, and contributed to writing and editing; Damal Kandadai S provided resources, assisted in data curation, and participated in writing and editing; Rathakrishnan D handled software and visualization, and contributed to writing the original draft; Moka MK was responsible for formal analysis, investigation, and writing and editing; Sundar L contributed through supervision, project administration, writing and editing; George M was involved in conceptualization, methodology, supervision, and writing and editing; all authors have read and approve the final manuscript.
Institutional review board statement: Ethical clearance was obtained from the Ethical Review Board of Chengalpattu Medical College, No. ICE-CMC/Approval/19/2023.
Informed consent statement: Both oral and written consent was obtained from all the dialysis patients coming to hospital.
Conflict-of-interest statement: The authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement - checklist of items, and the manuscript was prepared and revised according to the STROBE Statement - checklist of items.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Melvin George, MD, DM, Department of Clinical Research, Hindu Mission Hospital, No. 103 GST Road, West Tambaram, Chennai 600045, India.
drmelvingeorge@hindumissionhospital.org
Received: July 7, 2025
Revised: July 24, 2025
Accepted: October 27, 2025
Published online: December 25, 2025
Processing time: 170 Days and 17.7 Hours
BACKGROUND
End-stage renal disease is the final stage of chronic kidney disease, with hemodialysis as the primary treatment in India. Despite its prevalence, limited studies have focused on patient-reported outcomes, such as symptom burden and health-related quality of life.
AIM
To evaluate the symptom burden among adult hemodialysis patients and identify factors influencing their outcomes.
METHODS
A multi-center, cross-sectional study was conducted among 157 adult hemodialysis patients in Chennai from March 2024 to June 2024. The Dialysis Symptom Index tool was used to assess 30 physical and emotional symptoms. Correlations between symptom severity and clinical parameters, such as hemoglobin levels and urea reduction ratio (URR), were analyzed.
RESULTS
Moderate symptoms were reported by 48% of participants, with worry, insomnia, and feeling unwell identified as the most severe. Psychological symptoms significantly correlated with lower hemoglobin levels, while shortness of breath was linked to suboptimal URR values. Approximately 38% of patients had URR < 65%, which was associated with increased symptom burden.
CONCLUSION
Hemodialysis patients experience a substantial psychological and sleep-related symptom burden, emphasizing the need for dialysis adequacy and better hemoglobin management. Enhanced strategies addressing these factors could significantly improve patient outcomes.
Core Tip: This is the first study in India to use the Dialysis Symptom Index to examine the symptoms of hemodialysis patients in low-resource settings. Psychological and sleep-related symptoms, especially worry, insomnia, and fatigue, were the most common among 157 patients. Notably, lower hemoglobin and inadequate dialysis (urea reduction ratio < 65%) significantly correlated with greater symptom severity. The findings underscore the need for integrating patient-reported outcome measures into routine care to improve quality of life. Tailored interventions targeting anemia management and dialysis adequacy could meaningfully reduce symptom burden in this study population.
