Patient-reported outcomes in maintenance hemodialysis: a cross-sectional, multicenter study



The aim of this study is to assess patient-reported outcome measures (PROMs) related to symptoms among maintenance hemodialysis patients (MHDp).


This cross-sectional study was conducted between 2013 and 2015, with 336 MHDp from five hospital hemodialysis units. It included a comprehensive assessment of the prevalence and intensity of 30 common dialysis-related symptoms quality of life and daily function of MHDp, by using the Dialysis Symptom Index (DSI), Quality of Life Short Form (KDQOL-SF), and demographic and clinical characteristics.


The five most commonly reported symptoms were identified as tiredness (80%), difficulty becoming sexually aroused (72%), decreased interest in sex (72%), worrying (67%), trouble staying asleep (65%), and trouble falling asleep (64%). Based on the DSI, the mean Overall Burden of Symptoms (OBS), on a scale of 0–30, was 15.4 ± 6.7, while the mean Overall Symptom Severity Score (OSSS), on a scale of 0–150, was 54.8 ± 29.8. Multivariate quantile regression models indicated that major depression is consistently associated with both the OBS and OSSS across different quantiles, whereas time on dialysis > 24 months was associated with the OBS only. Both the OBS and OSSS were inversely associated with KDQOL-SF: the kidney-related (KDCS), physical (PCS) and mental aspects (MCS), across multiple quantiles in multivariate quantile regression models.


MHDp bear a heavy burden of symptom which are associated with time spent on dialysis as well as depression. Clinical and research resources should be directed at controlling symptoms, improving daily function, detecting depression, and bettering quality of life.

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TTF: Made a substantial contribution to the concept and design of the work and to the acquisition, analysis, and interpretation of data as well as drafted the article and approved the version to be published. This study was conducted as part of the requirements for TTF's graduation from the Kreitman School of Advanced Research Studies, Ben-Gurion University of the Negev. JD: Made a substantial contribution to the analysis and interpretation of data, drafted the article, and revised it critically for important intellectual content, then approved the version to be published. PS: Made a substantial contribution to the concept and design of the work and to the interpretation of data, revised it critically for important intellectual content, and approved the version to be published. All authors have participated sufficiently in the work to take public responsibility for appropriate portions of the content.

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Correspondence to Tatiana Talya Fleishman.

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Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committees in each of the five medical centers included (Kaplan Medical Center, approval number 0132–13-KMC; Meir Medical Center, Approval number 0060–12-MMC; Soroka Medical Center, Approval number 0287–11-SOR; Carmel Medical Center, Approval number 0090–13-CMC; Rabin Medical Center, Approval number 0674–14-RMC) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Fleishman, T.T., Dreiher, J. & Shvartzman, P. Patient-reported outcomes in maintenance hemodialysis: a cross-sectional, multicenter study. Qual Life Res 29, 2345–2354 (2020).

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  • Patient-reported outcomes
  • Symptoms
  • Maintenance hemodialysis
  • Palliative care
  • Cross-sectional study