Table 4.
Estimated symptom burden at admission for kidney transplantation and post-transplantation trajectories among recipients (n=521)
| Analysis | Estimated Score, Points (95% Confidence Interval) | Estimated Monthly Change in Score, Points per Month (95% Confidence Interval) | |||||
|---|---|---|---|---|---|---|---|
| At Transplantation | 3 months Post-Transplantation | 12 months Post-Transplantation | 0–3 Months Post-Transplantation | Pinteraction Value | 3–12 Months Post-Transplantation | Pinteraction Value | |
| Individual symptom scores (range 0–100) | |||||||
| Muscle soreness | 76.6 (72.9 to 80.2) | 82.4 (78.5 to 86.2) | 80.5 (75.1 to 85.9) | 1.92 (0.93 to 2.92) | −0.21 (–0.81 to 0.40) | ||
| Chest pain | 97.4 (95.9 to 99.0) | 98.2 (96.5 to 99.8) | 98.0 (95.7 to 100.0) | 0.25 (–0.21 to 0.70) | −0.02 (–0.29 to 0.26) | ||
| Cramps | 79.6 (76.5 to 82.7) | 92.9 (89.7 to 96.0) | 91.2 (86.9 to 95.5) | 4.43 (3.56 to 5.31) | −0.19 (–0.71 to 0.33) | ||
| Pruritus | 75.6 (72.6 to 78.7) | 93.2 (90.2 to 96.3) | 91.2 (87.0 to 95.3) | 5.86 (5.00 to 6.72) | −0.23 (–0.74 to 0.28) | ||
| Xeroderma | 72.6 (68.9 to 76.2) | 87.0 (83.3 to 90.6) | 86.3 (81.6 to 91.1) | 4.80 (3.86 to 5.73) | −0.07 (–0.62 to 0.48) | ||
| Dyspnea | 84.6 (81.4 to 87.7) | 85.8 (82.7 to 89.0) | 90.2 (85.9 to 94.6) | 0.42 (–0.32 to 1.15) | 0.49 (0.02 to 0.96) | ||
| Dizziness | 90.2 (87.9 to 92.4) | 92.2 (89.9 to 94.5) | 93.1 (89.9 to 96.4) | 0.67 (0.07 to 1.26) | 0.11 (–0.27 to 0.48) | ||
| Anorexia | 87.5 (84.7 to 90.4) | 96.2 (93.3 to 99.0) | 94.6 (90.7 to 98.6) | 2.88 (2.07 to 3.70) | −0.17 (–0.65 to 0.31) | ||
| Fatigue | 69.2 (65.5 to 72.9) | 83.8 (80.0 to 87.6) | 81.6 (76.6 to 86.7) | 4.86 (3.92 to 5.80) | −0.24 (–0.80 to 0.31) | ||
| Numbness | 85.2 (81.6 to 88.8) | 89.0 (85.3 to 92.6) | 88.6 (84.1 to 93.1) | 1.26 (0.50 to 2.01) | −0.04 (–0.49 to 0.41) | ||
| Upset stomach | 86.1 (83.1 to 89.0) | 93.9 (90.9 to 96.9) | 93.4 (89.3 to 97.6) | 2.60 (1.80 to 3.41) | −0.05 (–0.54 to 0.44) | ||
| Overall symptom score (range 0–100) | |||||||
| Overall score | 82.3 (80.4 to 84.2) | 90.6 (88.7 to 92.5) | 90.0 (87.7 to 92.4) | 2.75 (2.38 to 3.13) | −0.06 (–0.30 to 0.18) | ||
| Age | |||||||
| 18–49 yr a [a] | 81.9 (79.8 to 84.1) | 91.7 (89.6 to 93.8) | 90.9 (87.8 to 94.0) | 3.26 (2.67 to 3.84) | −0.09 (–0.47 to 0.28) | ||
| 50–64 yr [b] | 83.4 (81.2 to 85.6) | 91.1 (88.9 to 93.3) | 91.1 (87.9 to 94.2) | 2.57 (1.96 to 3.18) | −0.01 (–0.39 to 0.37) | ||
| Difference [b−a] | 1.5 (–1.0 to 3.9) | −0.6 (–3.1 to 1.9) | 0.2 (–3.9 to 4.2) | −0.68 (–1.53 to 0.16) | 0.11 | 0.09 (–0.45 to 0.62) | 0.75 |
| ≥65 yr [c] | 83.5 (80.7 to 86.3) | 89.8 (87.0 to 92.6) | 89.0 (84.9 to 93.1) | 2.09 (1.26 to 2.92) | −0.09 (–0.60 to 0.42) | ||
| Difference [c−a] | 1.6 (–1.5 to 4.6) | −1.9 (–5.0 to 1.2) | −1.9 (–6.8 to 3.0) | –1.17 (–2.18 to –0.15) | 0.02 | 0.00 (–0.63 to 0.64) | 0.99 |
| Sex | |||||||
| Men a | 81.7 (79.8 to 83.7) | 91.1 (89.1 to 93.1) | 89.8 (87.1 to 92.4) | 3.12 (2.64 to 3.60) | −0.15 (–0.46 to 0.16) | ||
| Women | 81.9 (79.6 to 84.2) | 88.3 (86.0 to 90.7) | 89.1 (85.9 to 92.3) | 2.14 (1.52 to 2.75) | 0.08 (–0.29 to 0.45) | ||
| Difference | 0.2 (–2.1 to 2.5) | –2.7 (–5.1 to –0.4) | −0.7 (–4.3 to 3.0) | –0.98 (–1.76 to –0.21) | 0.01 | 0.23 (–0.25 to 0.71) | 0.35 |
| Race | |||||||
| Non-Black a | 81.8 (79.8 to 83.7) | 90.9 (89.0 to 92.9) | 90.0 (87.4 to 92.6) | 3.06 (2.59 to 3.53) | −0.10 (–0.40 to 0.19) | ||
| Black | 82.1 (79.6 to 84.6) | 88.8 (86.3 to 91.2) | 88.8 (85.2 to 92.3) | 2.22 (1.60 to 2.84) | 0.00 (–0.40 to 0.40) | ||
| Difference | 0.3 (–2.0 to 2.6) | −2.19 (–4.5 to 0.1) | −1.3 (–5.1 to 2.6) | –0.84 (–1.62 to –0.06) | 0.03 | 0.10 (–0.40 to 0.60) | 0.69 |
| Diabetes status | |||||||
| Nondiabetic a | 81.7 (79.7 to 83.6) | 90.7 (88.8 to 92.6) | 90.8 (88.3 to 93.3) | 3.01 (2.57 to 3.46) | 0.01 (–0.27 to 0.28) | ||
| Diabetic | 82.6 (80.3 to 84.9) | 88.9 (86.6 to 91.3) | 86.4 (82.7 to 90.0) | 2.10 (1.39 to 2.80) | −0.28 (–0.74 to 0.17) | ||
| Difference | 1.0 (–1.5 to 3.5) | −1.8 (–4.3 to 0.8) | –4.4 (–8.5 to –0.3) | –0.92 (–1.75 to –0.09) | 0.03 | −0.29 (–0.82 to 0.23) | 0.27 |
| Frailty | |||||||
| Nonfrail a | 82.9 (81.0 to 84.8) | 90.9 (89.0 to 92.7) | 90.8 (89.0 to 92.5) | 2.66 (2.29 to 3.03) | −0.01 (–0.13 to 0.11) | ||
| Frail | 77.9 (74.5 to 81.4) | 86.7 (83.1 to 90.2) | 88.1 (84.8 to 91.3) | 2.90 (1.88 to 3.93) | 0.16 (–0.18 to 0.49) | ||
| Difference | –4.9 (–8.3 to –1.6) | –4.2 (–7.6 to –0.9) | −2.7 (–5.7 to 0.3) | 0.24 (–0.84 to 1.33) | 0.66 | 0.17 (–0.18 to 0.52) | 0.35 |
Recipients were enrolled at admission for transplantation. The overall symptom score ranged from zero to 100 points and was on the basis of self-reported burden of individual symptom/problem of kidney disease with five response options ranging from “not at all bothered” to “extremely bothered.” The individual symptom scores were transformed to a scale of 0–100 possible range, where a higher score represents lower burden. The overall symptom score was calculated by averaging across the 12 individual scores, so a higher symptom score represents a lower burden. Symptom burden was defined as very high: 0.0–71.0; high: 71.1–81.0; medium: 81.1–91.0; and low: 91.1–100.0. Estimated scores and monthly change (slope per unit time of 1 month) with 95% confidence intervals are presented from separate adjusted mixed effects models. The scores were estimated for the “reference population” in which age is set to 65 years, sex is set to men, race is set to non-Black, diabetes status is set to nondiabetic, and time on dialysis is set to zero, and they are estimated for the last day for the time interval. Monthly changes and differences that are statistically significant at P=0.05 are in bold. All models were adjusted for age, sex, Black race, diabetes status, and time on dialysis.
Reference group.