Pioneering patient-led intervention tackles multiple challenging symptoms in dialysis patients with success

When a patient with chronic kidney disease finally reaches the point that their kidneys fail, doctors have a treatment available: dialysis. But undergoing dialysis often brings a high burden of other unpleasant symptoms – fatigue, pain, and depression – that are outside the typical nephrologist’s wheelhouse and can be difficult to treat

A new patient-guided intervention using telemedicine improves these troublesome symptoms with results that persist for several months after the intervention ends, according to the results of a randomized clinical trial published in JAMA Internal Medicine by physician-scientists at the University of Pittsburgh and the University of New Mexico.

The researchers developed the Technology Assisted Stepped Collaborative Care (TĀCcare) trial to test whether 12 weekly sessions of cognitive behavioral therapy delivered via telemedicine either while patients receive their dialysis or at home could improve symptoms. To ensure the results weren’t simply an effect of the added attention from the tele-sessions, they had a comparison group of patients receive weekly health education via telemedicine.

The researchers recruited a diverse pool of 160 participants from Pennsylvania and New Mexico who were receiving dialysis and had clinically significant levels of fatigue, pain, or depression. They averaged 58 years old, and 28% were Black, 13% American Indian and 18% Hispanic.

Compared to those who received educational materials, patients who received TĀCcare had a 6% improvement in energy levels and a 10% improvement in pain severity, both of which were sustained for six months following therapy. They also had an improvement in depression symptoms, but it was very small.

Reference: Effects of Technology Assisted Stepped Collaborative Care Intervention to Improve Symptoms in Patients Undergoing Hemodialysis The TĀCcare Randomized Clinical Trial, JAMA Internal Medicine, DOI 10.1001/jamainternmed.2023.2215