Investigation of core symptoms during hemodialysis period in maintenance hemodialysis patients: a network analysis

Objective To explore the prevalence and severity of symptoms during hemodialysis period in maintenance hemodialysis(MHD) patients, and to construct symptom network to identify core symptoms and bridge symptoms.

Methods Using the convenience sampling method, a total of 541 MHD patients were admitted as study objects. Dialysis symptom index was used to investigate the prevalence and severity of 30 symptoms in MHD patients, and a symptom network model based on Fruchterman-Reingold algorithm was constructed to analyze the central indicators and determine the core symptoms and bridge symptoms.

Results The top five commonly occurring symptoms were fatigue (83.92%), dry skin (80.96%), dry mouth (78.37%), waking up easily(77.82%) and difficulty in falling asleep (76.16%). The most severe symptoms were dry skin, followed by pruritus, fatigue, dry mouth and waking up easily. The symptom network analysis showed that dry skin was most strongly associated with pruritus (weight=0.73)among physiological symptoms, irritability was most strongly associated with anxiety (weight=0.35) among mood symptoms. The centrality index showed that the intensity of sadness was the most centrality (r_S= 1.61) and was identified as the core symptom; fatigue had the highest mediation centrality (r_B=2.90) and irritability had the highest close centrality (r_C=1.61). Irritability, sadness, and inattention were identified as bridge symptoms, and their bridge centrality was 0.36, 0.22, and 0.21.

Conclusion Dry skin and sadness are respectively the most severe symptom and core symptom in MHD patients, while irritability, sadness and inattention are the bridge symptoms. Medical staff can formulate precise interventions based on core symptoms and bridge symptoms to improve the level of symptom management.