Cluster of symptoms in kidney failure: A systematic review.

Background: Chronic kidney disease is a global problem characterized by a progressive decrease in kidney function with associated symptoms. A better understanding of these symptoms could lead to the development of personalized strategies. Objective: This systematic review aims to describe the clusters of symptoms in kidney failure and categorize them according to their time of onset and how disabling they are for patients. Design: A systematic review was carried out. Methods: This systematic review was conducted according to the PRISMA declaration standards. The search engines used were initially limited to WOS, Embase, and PubMed, and they were employed between November 2022 and January 2023. In addition, the bibliographic search was supplemented with databases of the grey literature, such as OpenGrey, in May 2023. The following inclusion criteria were established: cross-sectional studies, studies on adult populations, and studies dealing with clusters of symptoms associated with kidney failure. Before an article was definitively selected, the checklist of the STROBE initiative, with a maximum of 22 points, was applied, assessing the quality of cross-sectional articles. Articles were selected independently and blinded by two researchers, and a third researcher was involved in case of disagreement. Results: After carrying out the bibliographic search, we found that eight articles, out of the 46 articles that were evaluated, fully met the inclusion criteria. Two tables were made, which include important information, such as the participants' profiles or the way the authors extracted a cluster of symptoms. Limitations: The main area for improvement is that it was not possible to perform a meta-analysis due to the methodology used in the articles analysed. Constraining the selection of articles to those written in Spanish or English could be a limitation as not all articles dealing with symptom clusters in kidney failure were considered. Conclusions: Common symptoms in clusters of symptoms in kidney failure were nausea or vomiting (gastrointestinal problems), fatigue or muscle weakness (neuromuscular symptoms/problems), low interest in sex or difficulty feeling sexually excited (sexual symptoms), dry skin or skin itching (skin problems), lack of appetite, feeling squeezed, feeling weak or dizzy and difficulty breathing (uraemic), fatigue or muscle weakness (energy/vitality), and chest pain (cardiac-related problems). Providing treatment based on clusters of symptoms would benefit the patient more than providing treatment based on isolated symptoms. The identification of symptom clusters in kidney failure has clinical relevance, and this research could facilitate the development of adequate intervention strategies, simplifying the treatment offered to patients and even reducing the side effects of treatments.