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

Table 1 Organ system distribution of symptoms studied

Number	Organ system	Symptoms studied
1	Cardiopulmonary	Swelling in legs
		Cough
		Shortness of breath
2	Neurology	Headache
		Numbness or tingling in feet
		Light-headedness
		Difficulty concentration
3	Gastrointestinal	Nausea
		Constipation
		Vomiting
		Diarrhea
		Decreased appetite
4	Endocrine	Decreased interest in sex
		Difficulty becoming sexually aroused
5	Pain	Bone/joint pain
		Chest pain
		Muscle cramp
		Muscle soreness
6	Dermatological	Dry mouth
		Dry skin
		Itching
7	Sleep	Trouble falling asleep
		Trouble staying asleep
		Feeling tired/lack of energy
		Restless legs
8	Psychological	Feeling nervous
		Feeling irritable
		Worrying
		Feeling bad
		Feeling anxious

Table 2 Descriptive statistics

Variable	n	mean ± SD
Age (years)	157	55.20 ± 13.38
Height (cm)	157	156.79 ± 9.61
Weight (kg)	154	59.79 ± 12.9
Body mass index	154	24.33 ± 4.55
Years on dialysis	157	3.27 ± 2.88
Last hemoglobin	157	9.54 ± 1.87
Pre-dialysis urea	157	90.70 ± 24.05
Post-dialysis urea	151	39.46 ± 16.02
Post weight (kg)	127	52.75 ± 20.12
Urea reduction ratio	157	57.29 ± 17.44

Table 3 Categorical variables, n (%)

Variable	Category
Sex	Female	46 (29.3)
	Male	111 (70.7)
Marital status	Unmarried	13 (8.3)
	Married	144 (91.7)
Hypertension	No	44 (28.0)
	Yes	112 (71.3)
	Missing	1 (0.6)
Diabetes mellitus	No	110 (70.1)
	Yes	47 (29.9)
Access type	Arteriovenous fistulas	142 (90.4)
	Catheter	15 (9.6)
Iron injection	No	34 (21.7)
	Yes	123 (78.3)
Recent hospitalization	No	146 (93.0)
	Yes	11 (7.0)

Table 4 Baseline characteristics of patients/dialysis treatment characteristics

Baseline characteristics of study group (n = 157)	Overall value	DSI score [low (< 15)]	DSI score [medium (15-31)]	DSI score [high (32-120)]
n	157	49	75	33
DSI score	0-120	31%	48%	21%
Demographic characteristics
Age (mean ± SD) (years)	55.20
Female	46	9	23	13
Male	111	40	52	20
Married	144	44	71	4
Unmarried	13	5	4	29

DSI: Dialysis Symptom Index.

Table 5 Dialysis Symptom Index scores

DSI score: Low (< 15)	DSI score: Medium (15-31)	DSI score: High (32-120)
31%	48%	21%

DSI: Dialysis Symptom Index.

Table 6 Prevalence of individual symptoms in the overall study group, n (%)

Symptoms studied	Moderate-severe (3, 4)	Mild (1, 2)	No symptoms (0)
Worrying	53 (33.7)	68 (43.3)	36 (22.9)
Trouble falling asleep	45 (28.6)	47 (29.9)	65 (41.4)
Feeling bad	44 (28)	69 (43.9)	44 (28)
Muscle cramps	37 (23.5)	59 (37.5)	61 (38.8)
Trouble staying asleep	41 (26.1)	33 (21)	83 (52.8)
Dry mouth	26 (16.5)	50 (31.8)	81 (51.5)
Feeling tired/lack of energy	21 (13.4)	69 (43.9)	67 (42.6)
Bone/joint pain	19 (12.1)	62 (39.4)	76 (48.4)
Dry skin	17 (10.8)	74 (47.1)	66 (42)
Itching	16 (10.1)	42 (26.7)	99 (63)
Feeling nervous	15 (9.5)	46 (29.2)	96 (61.1)
Swelling in legs	14 (8.9)	47 (29.9)	96 (61.1)
Cough	13 (8.2)	53 (33.7)	91 (57.9)
Muscle soreness	12 (7.6)	58 (36.9)	87 (55.4)
Headache	11 (7)	46 (29.2)	100 (63.6)
Numbness or tingling in feet	11 (7)	28 (17.8)	118 (75.1)
Difficulty concentration	11 (7)	57 (36.3)	89 (56.6)
Restless legs	11 (7)	58 (36.9)	88 (56)
Feeling irritable	11 (7)	35 (22.2)	111 (70.7)
Decreased interest in sex	11 (7)	16 (10.2)	130 (82.8)
Shortness of breath	10 (6)	52 (33.1)	95 (60.5)
Constipation	10 (6)	22 (14)	125 (79.6)
Decreased appetite	9 (5)	42 (26.7)	106 (67.5)
Chest pain	4 (2.5)	25 (15.9)	128 (81.5)
Vomiting	7 (4.4)	26 (16.5)	124 (78.9)
Nausea	7 (4.4)	15 (9.5)	135 (85.9)
Light-headedness	7 (4.4)	32 (20.3)	118 (75.1)
Difficulty becoming sexually aroused	5 (3.1)	13 (8.2)	139 (88.5)
Diarrhea	3 (1.9)	12 (7.6)	142 (90.4)

Table 7 Negative correlation between hemoglobin levels and symptoms- negative correlation

Category	Statistics	HB	Worry	Nervous	Feel sad
HB	Pearson correlation	1	-0.515	-0.622	-0.478
	P-value (2 tailed)		0.002	0.031	0.017
	n	46	46	46	46
Worry	Pearson correlation	-0.515	1	-0.408	-0.333
	P-value (2 tailed)	0.002		0.023	0.032
	n	46	46	46	46
Nervous	Pearson correlation	-0.622	-0.408	1	-0.421
	P-value (2 tailed)	0.031	0.023		0.001
	n	46	46	46	46
Feel sad	Pearson correlation	-0.478	-0.333	-0.421	1
	P-value (2 tailed)	0.017	0.032	0.001
	n	46	46	46	46

HB: Hemoglobin.

Table 8 Negative correlation between urea reduction ratio values and symptoms

Category	Statistics	URR	Shortness of breath	Headache	Feel tired
URR	Pearson correlation	1	-0.661	-0.701	-0.661
	P-value (2 tailed)		0.002	0.400	0.501
	n	46	46	46	46
Shortness of breath	Pearson correlation	-0.661	1	-0.324	-0.514
	P-value (2 tailed)	0.002		0.200	0.400
	n	46	46	46	46
Headache	Pearson correlation	-0.701	-0.324	1	-0.460
	P-value (2 tailed)	0.400	0.200		0.500
	n	46	46	46	46
Feel tired	Pearson correlation	-0.661	-0.514	-0.460	1
	P-value (2 tailed)	0.501	0.400	0.500
	n	46	46	46	46

URR: Urea reduction ratio.