Application and evaluation of structured symptom intervention program in patients with chronic kidney disease during peri-dialysis period

To evaluate the application efficacy of structured symptom intervention program in patients with chronic kidney disease (CKD) during the peri-dialysis period.

A non-simultaneous control study was conducted on 151 peri-dialysis outpatients having not yet initiated dialysis and being followed up who were subjected with convenience sampling from Department of Nephrology of Second Affiliated Hospital of Army Medical University from April to September 2024. According to the time period of their visits, the patients who visited from April to June 2024 were assigned into a control group (n=75), and those from July to September 2024 into an experimental group (n=76). The control group received conventional symptom intervention (telephone symptom reporting + health education), while the experimental group received the intervention as the control group and a structured symptom intervention program covering 4 evidence-based modules: symptom identification, assessment, intervention, and outcome. The efficacy of above treatments was evaluated before and at 3 months after intervention. Dialysis symptom index was used to assess the degree of symptom distress and the number of symptoms. MOS 36-Item Short Form Health Survey (SF-36) was employed to evaluate the quality of life. The differences in clinical indicators and endpoint events were compared between the 2 groups after intervention.

The experimental group obtained more significant reduction in the total score of symptom distress than the control group (P=0.021). After intervention, the number of symptoms was decreased in both groups (P<0.001), but no statistical difference was observed between the groups. The score of mental health dimension in SF-36 was obviously improved in the experimental group (P=0.004), which was notably better than that in the control group (P=0.033). The experimental group exhibited significantly higher prealbumin level than the control group (P=0.019), and stable albumin level, which was significantly decreased in the control group (P=0.035). The incidence of endpoint events was remarkably lower in the experimental group than the control group (P=0.028).

The structured symptom intervention program implements intervention through a closed-loop symptom module, which can effectively alleviate the symptom distress of patients during the peri-dialysis period, improve mental health and reduce the short-term risk for endpoint events.