Pain is highly prevalent among dialysis patients[7] although poor

Pain is highly prevalent among dialysis patients[7] although poorly recognized and often underreported by patients. Up to 50% of haemodialysis patients report pain when directly questioned, a similar percentage to those on the non-dialysis pathway.[5] In the month before death, this prevalence rises to over 70%.[4] Very few resources available for patients about dialysis mention this and death from kidney failure is often described as painless. The rise in reported pain may be an indicator of approaching the end of life for some patients. Prevalence of restless legs may be difficult to assess

because of previously poorly defined diagnostic criteria. The International Restless Legs Syndrome Nutlin 3 Study Group defined the following four features for diagnosis: The desire to move the legs in association with unusual or uncomfortable sensations deep within the legs.

Motor restlessness in an effort to remove these sensations. Symptoms become obvious or worse at rest and may be temporarily diminished by voluntary movement. Symptoms occur most frequently in the evening or early part of the night (this may be different in dialysis patients experiencing this problem while dialysing). It appears to be more prevalent in the conservatively managed group rather than in dialysis patients and may increase BGJ398 in severity as death approaches.[5] It may affect quality of life through sleep disturbance and is only occasionally mentioned in patient information leaflets. Pruritus is common in both dialysis and conservatively managed patients and may be particularly severe in haemodialysis patients towards the end of, or just after a dialysis session. It is often mentioned in patient information leaflets on chronic kidney disease but rarely mentioned in dialysis discussions and patients may not be aware that Methocarbamol starting dialysis may not solve this problem. In a large Dialysis Outcomes and Practice Patterns Study (DOPPS) report,[6] up to 50% of haemodialysis patients reported moderate to severe pruritus, a similar to percentage to those in stage 4–5 chronic kidney disease (CKD) not on dialysis.[8] Knowledge of this may

alter the patient’s decision about whether to dialyse but also highlights the need for the nephrologist to ask dialysis patients about this symptom and offer treatment. Tiredness and lack of energy are common symptoms and may be a marker indicating patient decline. They are difficult to define and may therefore be difficult to assess and manage. They are common on dialysis and many older patients describe severe tiredness after a dialysis session. Depression may be a contributing factor and is found in approximately 20% of haemodialysis patients[9] and 40% of conservatively managed patients with stage 5 CKD.[10] The use of erythropoiesis-stimulating agents to improve haemoglobin levels is of benefit in these patients and can help to alleviate symptoms.

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