| Description | Clinical utility |
| Edmonton Symptom Assessment System Revised:Renal (ESAS-r:Renal)[1-3] | |
| Thirteen visual analog scales with a superimposed 0 to 10 scale for pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, well-being, itching, sleep, restless legs, and other. The scale for each symptom is anchored by the words "no" and "severe" at 0 and 10, respectively. The sum of all scores makes up the overall symptom distress score, ranging from 0 to 130. | Comprehensive symptom screening – A short, practical tool for screening symptoms, which can be rapidly and repeatedly completed by patients and therefore incorporated easily into routine clinical care, even for patients who are preterminal. It has been translated into several languages. It was originally used in cancer and has been adapted for use in many disease states, allowing for comparisons to be made across disease states. |
| Palliative Care Outcome Scale-Renal (POS-renal)[4,5] | |
| Assesses 17 symptoms, which are rated in terms of how the patient has been affected by the symptom over the last three days from 0 (not at all) to 4 (overwhelmingly). Symptoms assessed are pain, shortness of breath, weakness or lack of energy, nausea, vomiting, poor appetite, constipation, mouth problems, drowsiness, poor mobility, itching, difficulty sleeping, restless legs or difficulty keeping legs still, anxiety, depression, changes in skin, and diarrhea. | Comprehensive symptom screening – This tool is simple to use and can be incorporated easily into routine clinical care, even for patients who are preterminal. It has been translated into several languages. It was originally used in cancer and has been adapted for use in many disease states, allowing for comparisons to be made across disease states. |
| Physical Symptom Distress Scale (PSDS)[6] | |
| Assesses 16 symptoms: swelling in feet, muscle cramps, fatigue, itching, nausea or vomiting, stiffness of joints, difficulty sleeping, poor appetite, pain, constipation or diarrhea, decrease in concentration, shortness of breath, numbness/tingling, dizziness, impaired visual ability, and headache. Symptoms are rated by patients on a four-point Likert scale (0 = not bothered at all, 4 = extremely bothered). | Comprehensive symptom screening – This tool was specifically designed for CKD patients, but there is not much experience with its use. There is some redundancy with respect to items pertaining to pain. It appears practical and simple enough to incorporate into routine clinical care. |
| Dialysis Symptom Index (DSI)[7] | |
| Assesses 30 symptoms, rating them from 1 (not at all bothered) to 5 (very much bothered). Symptoms related to pain include bone/joint pain, muscle soreness, muscle cramps, headaches, and chest pain. Other symptoms include constipation, diarrhea, nausea, vomiting, decreased appetite, swelling in legs, shortness of breath, light-headedness, restless legs, numbness, feeling tired, cough, dry mouth, difficulty concentrating, dry skin, itching, worrying, nervousness, trouble falling asleep, trouble staying asleep, feeling irritable, feeling sad, feeling anxious, decreased interest in sex, and difficulty becoming sexually aroused. | Comprehensive symptom screening – The tool is easy to use and can be self-completed by patients. Respondent burden is greater than for the ESAS-r:Renal or POS-renal, but less than the HRQL tools. There is limited experience with it being incorporated into routine clinical care for symptom screening. It was originally used in cancer patients prior to being adapted for use in CKD, allowing for comparisons to be made. |
| The Brief Pain Inventory (BPI)[8] | |
| Assesses the location, type (nociceptive versus neuropathic), and intensity of pain. It also evaluates the impact of pain on general activity, mood, walking ability, work, relationships, sleep, and enjoyment of life. The standard 32-question instrument has been condensed to a nine-question short form. | Pain assessment – This tool has been used successfully in clinical and research settings internationally to assess pain once identified as a problem. Seriously ill patients have been successful in completing this questionnaire. The short form is simple to use, with minimal respondent burden. |
| Short-form McGill Pain Questionnaire (SF-MPQ)[9] | |
| Describes the quality and intensity of pain. The scale is rated from 0 to 78 with higher scores reflecting worse pain. | Pain screening and assessment – This is not a simple screening tool for pain and does not assess other symptoms, decreasing its clinical utility for routine comprehensive symptom screening in CKD. It is incomplete as a pain assessment tool as it does not explore adequately the impact of the pain on function and quality of life. |
| Kidney Dialysis Quality of Life Short Form/ SF-36 (KDQOL-SF)[10] | |
| This is a self-reported HRQL measure developed for CKD patients as a less burdensome version of the longer KDQOL questionnaire. There are 37 questions, some with multiple stems, over 19 pages. The tool focuses on physical and emotional symptoms, effects on kidney disease on daily life, burden of disease, cognitive function, work status, sexual function, and quality of social interaction. There are also three quality-of-life scales focusing on social support, staff encouragement, and patient satisfaction. | HRQL: Takes approximately 30 minutes to complete in healthier individuals, but typically requires interviewer assistance and substantially more time in older, frail patients. It provides comprehensive HRQL information, but is more suited to a research environment where dedicated staff can help with the administration and complex scoring. |
| CHOICE Health Experience Questionnaire (CHEQ) + SF-36[11] | |
| This is a self-reported HRQL tool that incorporates an assessment of symptoms and was designed to complement the generic SF-36 (in a fashion similar to the KDQOL). | HRQL: Requires at least 30 minutes to complete in healthier individuals, but typically requires interviewer assistance and takes longer in older, frail patients. It provides comprehensive HRQL information, but is more suited to a research environment where dedicated staff can help with the administration and complex scoring. |
