Nutrition impact symptom clusters in a cohort of Indigenous Australian hemodialysis patients: new insights into the management of malnutrition?

Abstract

OBJECTIVE: To describe nutrition impact symptom clusters present in a large sample of Indigenous hemodialysis patients. DESIGN AND METHODS: This study was a cross sectional secondary analysis of data from a service audit conducted in 2016. All participants were hemodialysis patients from two satellite hemodialysis units in Central Australia. All participants completed a Patient Generated Subjective Global Assessment. Exploratory Factor Analysis was performed to identify nutrition impact symptom clusters. RESULTS: A total of 249 patients were included, representing 16 % of all Indigenous dialysis patients in Australia. Malnutrition was present in 29% of the sample. Five distinct nutrition impact symptom clusters were identified, accounting for 51.942% of the variance in symptoms. The five clusters extracted were: sore mouth (swallow problems, sore mouth, pain); nausea and vomiting (nausea, vomiting, taste changes); abnormal bowels (diarrhoea, constipation, depression); anorexia (no appetite, early satiety); dry mouth (dry mouth, dental problems). CONCLUSION: Malnourished patients experienced a significantly greater symptom burden in this study. This analysis extends the small evidence base about the nutrition impact symptom burden of Indigenous hemodialysis patients. Understanding symptom clusters and how symptoms are connected may be useful for triaging care and managing malnutrition.