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Titolo	Symptom clusters in incident dialysis patients: associations with clinical variables and quality of life
Autore	Melissa S. Y. Thong1, Sandra van Dijk2, Marlies Noordzij3, Elisabeth W. Boeschoten4, Raymond T. Krediet5, Friedo W. Dekker1 and Adrian A. Kaptein2 for the NECOSAD Study Group∗ - 1Department of Clinical Epidemiology, 2Department of Medical Psychology, Leiden University Medical Centre, Leiden, 3Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, 4Hans Mak Institute, Naarden and 5Department of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
Referenza	Nephrol Dial Transplant 2008; doi: 10.1093/ndt/gfn449
Contenuto	Abstract Background. To date, the pathophysiology underlying symptoms in renal patients is still unclear. Symptom management research suggests that identification of related clusters of symptoms could provide insight into underlying determinants associated with multiple symptom experience. Theoretically, symptoms within a cluster could have a synergistic relationship.We aimed to identify symptom clusters in incident dialysis patients, and investigated associations between symptom clusters, clinical variables, functional status as measured by the Karnofsky Index and quality of life. Methods. 1553 haemodialysis (HD) and peritoneal dialysis (PD) patients completed the Kidney Disease Quality of Life Short Formsymptom/problem list at 3 months after the start of dialysis. Principal component analysis using varimax rotation was used to identify symptom clusters. Results. Patients were bothered by an average of 2.8 (±2.4) symptoms of ?moderate bother? or more. Three clusters were identified, explaining 49% of the total variance. All clusters showed strong negative associations with the SF-36 quality of life dimensions (−0.142 to −0.593) and with functional status (−0.130 to −0.332) in HD and PD patients. In contrast, only the clinical variables serum albumin (−0.084 to −0.232) and haemoglobin (−0.068 to −0.126) were associated with all clusters in HD patients, and Kt/Vurea (−0.089 to −0.125) in PD patients. Conclusions. Symptom clustering does not explain the lack of meaningful associations between symptoms and clinicalvariables. Strong associations of symptom clusters withquality of life dimensions suggest that psychological factors could better explain symptom burden. Patients? perceptionsof symptoms should be routinely assessed as part of clinical care to improve self-management strategies.
Data	10.09.2008

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