Symptom distress and day-to-day changes in functional status in chronic hemodialysis patients.

The purposes of this study were to examine changes in center-based hemodialysis patients' levels of daily functional status (FS) during the week and to examine the extent to which symptom distress explained variations in daily functional status. A correlational panel study design was used. The sample consisted of 104 chronic incenter hemodialysis patients recruited from two outpatient hemodialysis centers in a mid-Atlantic state. The Inventory of Functional Status was administered daily for 7 consecutive days to assess daily functional status. The Kidney Disease Quality of Life Symptom Scale was administered daily for 7 consecutive days to examine daily symptom distress. Study findings indicated suboptimal levels of FS at baseline, a significant decline in FS the day before the first dialysis session of the week compared to baseline, and a significant decline in FS on the second dialysis day of the week compared to the previous and subsequent nondialysis days. Symptom distress explained 6% of the variation in FS on these 2 days. In conclusion, incenter hemodialysis patients' baseline levels of FS are suboptimal, and FS declines further on the day before the first dialysis session of the week and the second dialysis day of the week. Symptom distress partially accounts for the decline in FS on those days. These findings indicate a need for ongoing FS assessment, implementation of strategies to improve FS, and symptom management in center-based chronic hemodialysis patients.