MO832SYMPTOM BURDEN AND QUALITY OF SLEEP IN MAINTENANCE HAEMODIALYSIS PATIENTS

Background and Aims

The number of patients with end-stage renal disease is growing rapidly worldwide and their survival on haemodialysis (HD) is increasing as a result of technique and treatment improvements. Nevertheless, longer survival and increasing complexity of the comorbid disorders contribute to a series of symptoms which affect patients’ physical and mental health. In the present study we aimed to examine the symptom distress and quality of sleep in patients treated with chronic HD.

Method

In this cross-sectional study, we recruited 304 (179 males and 125 females, age range 20 - 85 years, time on dialysis 3 - 324 months) out of 372 HD patients from five centres. All patients were under stable condition, without any severe acute comorbidities, and able to understand and fill-in the self-administered questionnaires. Standard laboratory parameters and Kt/V were determined in all patients. Quality and patterns of sleep were assessed by the Pittsburgh Sleep Quality Index (PSQI), while physical and emotional symptoms and their severity were evaluated by the Dialysis Symptom Index (DSI). Other relevant demographic and clinical data were obtained from patients’ medical records. The results were analyzed with independent sample T test and χ2 statistic.

Results

The average PSQI was 7.62±4.44, average symptom burden 15.49±12.85, and average symptom severity 23.38±18.78. Almost two thirds of the patients (63.8%) had poor sleep quality. The average sleep duration, latency and efficiency were 6.85±1.75 hours, 36.01±34.99 minutes and 81.51±21.57% respectively. Nearly half of the patients (45%) used sleep medications.

Women, unemployed and diabetic patients had significantly worse quality of sleep than men (8.41±4.33 vs. 7.08±4.43; p=0.001), employed (7.75±4.47 vs. 4.38±1.89; p<0.01) and nondiabetic (8.89±4.59 vs. 7.36±4.40; p=0.041) patients respectively. Other demographic (age, level of education, marital status, smoking habit), clinical (body mass index, comorbidities, dialysis vintage, shift, and adequacy, type of membrane and vascular access) and standard laboratory parameters were not significantly associated with sleep quality.

Poor sleepers had significantly higher symptom burden (17.81±12.97 vs. 11.42±9.78; p<0.01) and symptom severity (27.67±19.73 vs. 15.81±14.16; p<0.01). The most prevalent and at the same time the most bothersome symptoms were difficulty becoming sexually aroused (63.2%), feeling tired or lack of energy (60.5%), decreased interest in sex (57.6%), feeling nervous (57.2%) and dry skin (53.3%). Shortness of breath (p=0.011), dizziness (p=0.005), restless legs (p=0.011), tingling in feet (p=0.005), lack of energy (p=0.001), cough (p=0.001), dry mouth (p=0.017) and bone/joint pain (p=0.016) were significantly more prevalent in poor sleepers.

Conclusion

Patients on HD experience high number of symptoms and often have poor quality of sleep which may affect their well-being. These results support the likely importance of routine symptom assessment in dialysis centres to guide systematic symptom management and provide appropriate psychosocial and clinical support.

MO748CORONARY ARTERY CALCIUM SCORE IN ASYMPTOMATIC PATIENTS RECEIVING CHRONIC HAEMODIALYSIS

Background and Aims

Vascular calcification has been reported to be an independent predictor of all-cause mortality and cardiovascular (CV) events in patients with end-stage renal disease. Even in previously asymptomatic patients, early years of haemodialysis (HD) are associated with high CV morbidity and mortality rates. Thus, it is important to precisely and timely identify individuals at risk of coronary artery disease (CAD) who would benefit from further CV treatment. Coronary artery calcium score (CACS) is an accurate tool for noninvasive assessment of CAD. This study aimed to evaluate CACS in asymptomatic HD patients in early years of treatment.

Method

This multicentric observational study included 60 patients receiving chronic HD for less than 4 years, with neither signs nor symptoms of CV disease. All patients underwent multislice computed tomography to identify coronary artery calcifications according to the standard procedure. CACS was calculated by the Agatston method individually for the left main, left circumflex, left anterior descending, and right coronary arteries and then summed to calculate the total CACS for each patient. Patients were distributed based on CACS: group 1 with CACS = 0, group 2 with CACS ranging from 1 to 400, and group 3 with CACS > 400.

Results

Nine patients (89% men) had CACS = 0, 34 (47% men) had CACS 1-400, and 17 (76.5% men) had CACS > 400 (χ2 = 7.467; p = 0.024). The mean age was 51±7, 61±12 and 64±8 years in groups 1, 2 and 3, respectively (p = 0.016). Patients in group 1 were significantly younger than patients in group 2 (p = 0.046) and group 3 (p = 0.012). The highest percentage of men was observed in group 1 (x2 = 7,668; p = 0.022). Other investigated demographic characteristics (dialysis vintage, body mass index, smoking history, family CV history, systolic and diastolic blood pressure), comorbidities (hypertension, diabetes, hyperparathyroidism, hyperlipidemia) and therapy (angiotensin converting enzyme inhibitors, angiotensin receptor blockers, statins, vitamin D, CaCO3, dialysate-magnesium concentration) did not differ significantly between the investigated groups. CACS showed statistically significant negative correlation with the serum iron (σ = - 0.351; p = 0.007), while other laboratory parameters (including calcium phosphate product) did not show statistically significant correlations.

Conclusion

Older age and low serum iron are associated with higher CACS in asymptomatic patients in the early years of HD. Therefore, these patients should be closely monitored for the early signs of CV disease.