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Symptoms in Kidney Transplant Recipients Differ by Sex, Age

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Age and sex affect how kidney transplant recipients experience symptoms, new study findings suggest.

Investigators assessed the incidence and severity of 62 symptoms via questionnaire among 631 Dutch kidney transplant recipients with a functioning graft. The questionnaires included the 12-item Short Form, Dialysis Symptom Index (DSI), and the Modified Transplant Symptom Occurrence and Symptom Distress Scale-59 Items Revised (MTSOSD-59R).

Patients experienced a median 14 symptoms, Denise M.J. Veltkamp, MD, of Leiden University Medical Center in the Netherlands, and colleagues reported in Nephrology Dialysis Transplantation. The most commonly reported symptoms included bruises, tiredness, lack of energy, urge to urinate at night, and dry skin.

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Overall, the kidney transplant recipients had a symptom burden of 20, the investigators reported. Across patient subgroups, the most burdensome symptoms were sexual problems. According to Dr Veltkamp’s team, health care providers frequently fail to ask patients about these sexual issues and may not be aware of therapeutic options or feel comfortable discussing them.

Mean physical and mental health related quality of life (HRQOL) scores were 43.7 and 47.8, respectively. For each extra symptom, patients’ physical and mental HRQOL significantly decreased -0.41 and -0.51, the investigators reported. Kidney transplant recipients had mean physical and mental HRQoL below the Dutch national average.

Women reported 4.1 more symptoms then men and scored 8.0 points higher on symptom burden. Women and older adults reported lower physical and mental HRQOL. Depression was more prevalent among women and younger kidney transplant recipients aged 18 to 50 years. Changes in physical appearance also were reported more often by women and the youngest age group. Younger adults more often reported skin spots, hair growth on face/body, and swollen gums. Headaches were more common among younger adults. Older adults had a higher prevalence of bone or joint pain, bruises, erectile problems, muscle soreness, dry mouth, and vision impairment.

“Insight into KTRs’ symptom experience, captured by (e)PROMs, is necessary to successfully develop and implement tailored interventions aimed at reducing symptom experience and subsequently improving HRQOL in KTRs,” according to Dr Veltkamp’s group.

The investigators could not rule out selection or survivor bias.

In an accompanying editorial, Hannah Beckwith, MD, MPH, and Edwina A. Brown, MD, of Imperial College London in the UK, noted that menstruation cycle and differential metabolism of drugs may influence symptoms. They noted that women in the study reported significantly more abdominal pain, sweating, and hair thinning or loss compared with men, which may relate to menstruation and menopause.

According to the editorialists, “It is time for sex and gender-related differences to become standard in kidney disease research: we can do better.”


Veltkamp DMJ, Wang Y, Meuleman Y, et al. Age and gender differences in symptom experience and health-related quality of life in kidney transplant recipients: a cross-sectional study. Nephrol Dial Transplant. Published online January 27, 2023. doi:10.1093/ndt/gfad023

Beckwith H, Brown EA. Health-related quality of life in kidney transplant recipients: can we do better?Nephrol Dial Transpl. Published online April 4, 2023. doi:10.1093/ndt/gfad060

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Schedule12 Apr 2024