between hemodialysis and non-hemodialysis days.Ecological momentary assessment can provide insights into the complex, dynamic symptom experiences of patients on hemodialysis. Background Patients with ESKD on hemodialysis experience a high symptom burden, which is compounded by unpredictable fluctuations in symptom severity. Few studies have used ecological momentary assessment to determine how symptoms vary over time. This study aimed to characterize the diurnal and day-to-day variability in symptoms among patients receiving hemodialysis. Methods Patients enrolled in the Technology-Assisted Collaborative Care trial rated the intensity of physical, cognitive, and mood symptoms using an automated telephone-administered version of the Daytime Insomnia Symptom Scale at four time points (morning, early afternoon, late afternoon, evening) for seven consecutive days at baseline. Confirmatory factor analysis was used to verify the original four-factor solution for the Daytime Insomnia Symptom Scale: sleepiness/fatigue (SF), alert cognition (AC), positive mood (PM), and negative mood (NM). Symptom domain scores were calculated for each time point, and mixed modeling with random patient effects was used to examine differences in daily symptoms at daily time points between hemodialysis and non-hemodialysis days after controlling for age, sex, race, and comorbidity burden. Results One hundred sixty patients were enrolled (mean±SD age 58±14 years, 45% women, 52% White). Diurnal symptom variation existed; trends were nonlinear and differed by hemodialysis versus non-hemodialysis days. Day-to-day symptom variation also existed; patients endorsed better physical, cognitive, and mood states (i.e., higher AC and PM) as well as lower symptom burden (i.e., lower SF and NM) on non-hemodialysis days compared with hemodialysis days at all time points. The greatest day-to-day mean differences (MDs) were observed in the early afternoon for all symptom domains: AC (MD=0.17 P < 0.001), PM (MD=0.28, P < 0.001), SF (MD=−0.66, P < 0.001), and NM (MD=−0.26, P < 0.001). Conclusions Patients with ESKD demonstrate diurnal variation in symptoms and greater symptom burden on hemodialysis days compared with non-hemodialysis days, with the most extreme differences in symptom severity occurring in the early afternoon. Clinical Trial registration number: ClinicalTrials.govNCT03440853....

中文翻译：

---

终末期肾病患者的昼夜和每日症状变化：一项生态瞬时评估研究


在血液透析和非血液透析日之间。生态瞬时评估可以深入了解血液透析患者复杂、动态的症状体验。背景 接受血液透析的 ESKD 患者会经历很高的症状负担，而症状严重程度的不可预测的波动又加剧了这种情况。很少有研究使用生态瞬时评估来确定症状如何随时间变化。本研究旨在描述接受血液透析的患者症状的昼夜和日常变化。方法 参加技术辅助协作护理试验的患者在四个时间点（早上、下午早些时候、下午晚些时候、晚上）使用自动电话管理版本的日间失眠症状量表对身体、认知和情绪症状的强度进行评分，连续 7 天在基线时。验证性因子分析用于验证日间失眠症状量表的原始四因素解决方案：嗜睡/疲劳 （SF） 、警觉认知 （AC）、积极情绪 （PM） 和消极情绪 （NM）。计算每个时间点的症状领域评分，并使用具有随机患者效应的混合模型来检查在控制年龄、性别、种族和合并症负担后，血液透析和非血液透析日之间每日时间点每日症状的差异。结果 共纳入 160 例患者 （平均 ±SD 年龄 58±14 岁，45% 为女性，52% 为白人）。存在昼夜症状变化;趋势是非线性的，血液透析与非血液透析天数不同。日常症状也存在差异;患者认可更好的身体、认知和情绪状态（即更高的 AC 和 PM）以及更低的症状负担（即，与血液透析日相比，在所有时间点的非血液透析日降低 SF 和 NM）。所有症状域的每日平均差 （MDs） 在下午早些时候观察到最大：AC （MD=0.17 P < 0.001）、PM （MD=0.28，P < 0.001）、SF （MD=-0.66，P < 0.001） 和 NM （MD=-0.26，P < 0.001）。结论 与非血液透析日相比，ESKD 患者在血液透析日表现出症状的昼夜变化和更大的症状负担，其中症状严重程度的最极端差异发生在下午早些时候。临床试验注册号：ClinicalTrials.govNCT03440853....