Kidney Week 2025 Annual Meeting-Addressing Symptoms in Dialysis-Dependent Kidney Disease

Video Transcription

Video Summary

The session, led by Devika Nair and Michael Fisher, focused on symptom management in dialysis-dependent kidney disease, emphasizing that “good numbers” (labs, dialysis dose) often don’t reflect how patients actually feel.<br /><br />Dr. Raj Mehrotra reviewed evidence that dialysis patients typically experience 8–10 concurrent symptoms. While starting dialysis can improve some uremic symptoms (e.g., appetite, dyspnea), many symptoms persist despite initiation or intensification. Symptom “clusters” and “cascades” suggest shared root causes (e.g., depression driving insomnia and fatigue), so treating underlying issues may relieve multiple symptoms. Higher symptom burden correlates with worse physical and mental quality of life and greater healthcare utilization (e.g., falls, hospitalizations). Patient priorities include fatigue, insomnia, cramps, anxiety, depression, and frustration, and simply acknowledging symptoms matters. He highlighted effective treatments for some symptoms (e.g., difelikefalin for pruritus; CBT for depression and pain) and described an implementation model embedding depression care in dialysis units, training social workers to deliver CBT via telehealth and supporting nephrologists in antidepressant prescribing.<br /><br />Dr. Banisha Jam discussed trial design considerations for symptom-focused clinical trials: early and continuous patient involvement, pragmatic/hybrid effectiveness-implementation designs, recruitment/retention challenges in highly symptomatic patients, choosing appropriate controls, selecting clinically meaningful endpoints (not just statistically significant ones), and careful PROM selection given major heterogeneity (e.g., 43 fatigue tools). She emphasized timing of assessments in hemodialysis and tools like ecological momentary assessment.<br /><br />Patient advocate Dave White described how meaningful patient partnership improves research relevance and feasibility, highlighting KHI’s patient-preference survey for wearable dialysis devices and the HOPE trial, where patient input reshaped the study toward pain interference.<br /><br />Dr. Daniel Sucor explained how CBT works, why adaptations are needed in dialysis (complex comorbid symptom burdens, limited resources), and argued for integrated behavioral health models within nephrology care. Q&A addressed barriers to reimbursement and limited insomnia treatment evidence.

Asset Subtitle

Moderator(s): Michael Fischer, Devika Nair

Presentation(s):

Burden of Symptoms in ESKD - Rajnish Mehrotra
Methodological Considerations for Clinical Trials Addressing Symptoms - Manisha Jhamb
Partnering with Investigators to Improve Research: A Patient's Perspective - David White
Cognitive Behavioral Therapy: How It Works and How to Incorporate It into Care - Daniel Cukor

Meta Tag

Date 11/6/2025

Pathway 1 Dialysis

Session ID 507319

Keywords

dialysis-dependent kidney disease

symptom management

symptom burden

patient-reported outcomes (PROMs)

symptom clusters and cascades

quality of life

fatigue and insomnia

depression and anxiety

cognitive behavioral therapy (CBT)

integrated behavioral health in dialysis units

difelikefalin for uremic pruritus

pragmatic effectiveness-implementation trials

patient engagement in clinical trial design