Comparison of fatigue, pain and depression in patients with advanced kidney disease and cancer - symptom burden and clusters.

While symptom clusters have been studied in the context of cancer, few data exist in chronic and end stage kidney disease (CKD/ESKD) patients.

To (1) characterize and compare symptom cluster phenotypes in patients with advanced CKD, ESKD and cancer, and (2) explore predictors of symptom clusters.

We conducted secondary data analysis of three prospective studies in which pain, depression, and fatigue were assessed in patients with stage 4-5 CKD, ESKD and gastrointestinal (GI) cancer. Tetrachoric correlations between these symptoms were quantified and partitioning around medoids algorithm was used for symptom cluster analysis.

In the 82 CKD, 149 ESKD, and 606 cancer patients, no differences in the average fatigue (p=0.17) or pain levels (p=0.21) were observed. Over 80% of patients in each group had at least one symptom. Moderate or severe depressive symptoms were more common in patients with cancer (31% versus 19% in ESKD versus 9% in CKD; p<0.001). Mild-moderate correlations were observed between the 3 symptoms in ESKD and cancer patients. Three distinct clusters were observed in each group. In ESKD, the HIGH cluster (with high probability of pain, depression, and fatigue) had higher body mass index (p<0.001) and antidepressant use (p=0.01). In cancer patients, the HIGH cluster patients were more likely to be female (p=0.04), use antidepressants (p=0.04), have lower serum albumin (p<0.001) and hemoglobin (p=0.03) compared to the other 2 clusters.

While the burden of fatigue, pain and depressive symptoms for CKD and ESKD patients are similar to patients with GI cancer, symptom cluster phenotypes differed between the groups as did the predictors of symptom clusters.

Journal of pain and symptom management. 2018 Dec 12 [Epub ahead of print]

Manisha Jhamb, Khaled Abdel-Kader, Jonathan Yabes, Yisi Wang, Steven D Weisbord, Mark Unruh, Jennifer L Steel

Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: ., Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN., Center for Research on Heath Care, Division of General Internal Medicine, Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA., Department of Surgery, University of Pittsburgh, Pittsburgh, PA., Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, PA., Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine Albuquerque, NM., Department of Surgery, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA.