Symptom Trajectories in the Electronic Health Record during the Transition to Maintenance Dialysis

Clin J Am Soc Nephrol. 2023 Nov 14. doi: 10.2215/CJN.0000000000000371. Online ahead of print.ABSTRACTHow symptoms recorded in the electronic health record (EHR) change during the transition to dialysis has not been fully explored. We used the Optum® de-identified Integrated Claims-Clinical Dataset to identify individuals with CKD stages 4 or 5 who transitioned to dialysis. We searched structured data elements from clinical notes, identified by natural language processing, for symptoms recorded across weekly intervals in the 6 months before and after dialysis initiation and estimated changes in the odds of a symptom being recorded with an interrupted time series analysis using segmented logistic regression. The cohort comprised 728 individuals (aged 67.7 ± 13.1 years, 44% women, 56% White, 30% Black). Prior to dialysis initiation, 83% were recorded as having pain, 68% fatigue/weakness, 66% shortness of breath, 61% nausea/vomiting, and 37% difficulty concentrating. Before dialysis initiation, odds of pain being recorded increased (slope: OR 1.02 per week, 95% CI 1.01 - 1.03); initiation was associated with a decrease (intercept change: OR 0.70, 95% CI 0.59 - 0.82). After initiation, odds of pain were unchanged (post-dialysis slope: OR 1.00 per week, 95% CI 0.99 - 1.01), although this represented an improved trajectory relative to the pre-dialysis period (change in slope: OR 0.98 per week, 95% CI 0.96 - 0.99). For fatigue/weakness, odds increased before initiation (OR 1.03 per...
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Source Type: research