||Jing Zhang1, Salam El-Majzoub2, Madeline Li3, 4, Tibyan Ahmed1, Joyce Wu2, Mark. L. Lipman5, Ghizlane Moussaoui2, Karl J. Looper2, Marta Novak1, 4, Soham Rej2, Istvan Mucsi1, 4
||Background: Previous studies have reported high rates of emergency room (ER) use and hospitalization among patients with end stage kidney disease. The Edmonton Symptom Assessment System (ESAS) previously showed the presence of distinct physical and emotional factors. Self-reported symptom burden as assessed by the ESAS, may be an important predictor of healthcare use in hemodialysis patients.
Objectives: To assess whether symptom burden, as measured by ESAS, is associated with healthcare use among hemodialysis patients.
Methods: Prospective single-center cohort study of adult patients on maintenance hemodialysis. Patients were recruited from Jewish General Hospital, Montreal. All participants provided informed consent and were able to communicate in English or French. Participants completed ESAS at baseline. Demographic, clinical information, number of hospital admissions, and ER visits during a 12-month period after baseline assessment was extracted from electronic medical records. Total healthcare use was defined as the sum of the number of ER visits and hospital admissions during the study period. Moderate to severe symptom burden was defined with cut-off at >30 on the ESAS. Association between symptom burden versus healthcare use was assessed using Zero-inflated Poisson and logistic regression.
Results: Of the 80 patients, 30% were female and 68% were married, mean(Standard Deviation [SD]) age was 71(12.6) years with a median(Interquartile range[IQR]) dialysis vintage of 2.3(1.0 ? 3.8) years. Median(IQR) number of comorbidities was 7(4.5 ? 8.0). Moderate to severe global symptom burden was significantly associated with increased likelihood of ER visits (Incident Rate Ratio (IRR)=1.81, (P=0.003, 95% CI 1.22 ? 2.69) and total healthcare use (IRR=1.60, P=0.005, 95% CI 1.15 ? 2.23). This association remained significant after adjusting for sociodemographic (age, sex and marital status), and clinical (albumin level, number of comorbidities and years of dialysis) factors. There were no significant association between hospital admission and symptom burden measured by the ESAS.
Conclusion: Self-reported symptom burden predicts healthcare use among patients on maintenance hemodialysis. Further research is needed to determine if a systematic use of self-reported outcomes identifies patients requiring enhanced support, to reduce healthcare use.