#2882 Network analysis of hemodialysis patients' symptoms

Abstract Background and Aims Individuals undergoing maintenance hemodialysis frequently report a high symptom burden that interferes with their quality of life. While the prevalence of symptoms has been previously well-studied in hemodialysis patients, exploring connections and relationships between symptoms using network analysis has been less well-investigated therefore we aimed to perform network analysis for symptoms experienced by a large cohort of hemodialysis patients. Method This was a cross-sectional study involving hemodialysis patients enrolled from 27 hemodialysis units distributed in different regions in Egypt. Symptoms were assessed using the validated Arabic version of the Chronic Kidney Disease Symptom Burden Index (CKD-SBI), which assesses the prevalence, distress, severity, and frequency of 32 symptoms. JASP version 0.18.0 (JASP Team) was used for network analysis. To gain additional insights into the structural importance of each node (i.e., symptom) in the network, three centrality indices (i.e., betweenness, closeness, strength) were estimated. Results A total of 1156 patients were included in the study. Network analysis investigated the relationship between 31 common symptoms among patients. It was found that the symptoms with the highest betweenness were nausea (rb = 2.70) and feeling nervous (rb = 2.33), indicating that they act as bridge symptoms with the greatest effects in symptom interactions. The symptoms with the highest closeness were feeling nervous (rc = 1.714) and nausea (rc = 1.497), denoting that they had the closest relationship with other symptoms. The symptoms with the highest strength were feeling nervous (rs = 2.386) and worrying (rs = 1.659), signifying that they were the most important symptoms in the network. Conclusion Feeling nervous and worrying were the core symptoms of the network. While bone or joint pain, feeling tired or lack of energy, and muscle cramps were the most prevalent symptoms, their low centrality indicates that they could be sentinel symptoms for other symptoms. Early discovery and management of negative emotions could potentially be a key to symptom management in hemodialysis patients, as it positively affects the management of other symptoms.