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“Multidimensional symptom clusters: an exploratory factor analysis in advanced chronic kidney disease.”



Authors: Hayfa ALMUTARY,  Clint DOUGLAS & Ann BONNER ( 2016 )
Journal of Advanced Nursing 72(10), 2389–2400. doi: 10.1111/jan.12997


Aims: To explore the existence of symptom clusters in advanced chronic kidney disease.

Background: People with chronic kidney disease commonly report multiple symptoms. However, the complex relationships among these symptoms are still poorly understood.

Design:  Cross-sectional.

Methods:  A total of 436 people with stage 4 and 5 chronic kidney disease were recruited from three tertiary hospitals during 2013–2014. Participants completed the Chronic Kidney Disease–Symptom Burden Index that assesses four symptom dimensions (occurrence, distress, severity and frequency) of 32 symptoms.

Exploratory factor analysis was used to identify symptom clusters across each symptom dimension. Core symptoms in each cluster were determined based on stability across dimensions and clinical plausibility. A high cutoff of 050 for factor loading was used for all analyses.

Results: Five symptom clusters were consistently identified across all symptom dimensions: fluid volume symptoms, neuromuscular symptoms, gastrointestinal symptoms, sexual symptoms and psychological symptoms. Overall, clusters ranged from 2-10 symptoms. Several symptoms were also interconnected with
multiple clusters. Fatigue cross-loaded on all five clusters, whereas sleep disturbance and restless leg symptoms cross-loaded across three clusters.

Conclusions: Adopting a symptom cluster approach has the potential to significantly advance symptom assessment and nursing care for people in advanced stages of chronic kidney disease. Routine clinical assessment and management strategies targeted at the cluster level should have synergistic effects
in reducing symptoms. Fatigue is a pervasive symptom in advanced chronic kidney disease that is interconnected with global symptom burden, suggesting better management of symptom clusters may also reduce fatigue.

Correspondence to: H. Almutary. e-mail: