Dialysis Symptom Index: Patient-reported outcome measures study of dialysis patients in low resource settings in India

doi:10.5527/wjn.v14.i4.111639

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Dec 25, 2025 (publication date) through Dec 23, 2025

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World Journal of Nephrology

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2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Nephrol. Dec 25, 2025; 14(4): 111639
Published online Dec 25, 2025. doi: 10.5527/wjn.v14.i4.111639

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.

Data sharing statement: A technical appendix and statistical data set will be available from the corresponding author at drmelvingeorge@hindumissionhospital.org upon reasonable request.

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

Core Tip

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.