Exploring symptom clusters in Chinese patients with peritoneal dialysis: a network analysis

Figures & data

Table 1. Demographic and clinical data of PD patients (N = 602).

Variables	N (%)
Age (years)
≤30	47 (7.81)
31–50	308 (51.16)
51–70	230 (38.21)
≥71	17 (2.82)
Gender
Male	285 (47.34)
Female	317 (52.66)
Ethnicity
Han Chinese	580 (96.35)
Ethnic minority	22 (3.65)
Education level
Primary school and below	134 (22.26)
Secondary school	202 (33.55)
High school/technical high school	143 (23.75)
College and above	123 (20.43)
Marital status
Married	406 (67.44)
Divorced	52 (8.64)
Widowed	24 (3.99)
Unmarried	120 (19.93)
Healthcare payment mode
Health insurance	590 (98.01)
Self-pay	12 (1.99)
Dialysis duration
0–1 year	218 (36.21)
1 to <2 years	94 (15.61)
≥2 years	290 (48.17)
Primary kidney disease
Glomerulonephritis	264 (43.85)
Hypertension	138 (22.92)
Diabetes	114 (18.94)
Others	86 (14.29)
Total score of symptoms burden, mean (SD)	10.97 ± 9.09

SD: standard deviation.

This table presents data from 602 participants, with an average age of 47.8 ± 16.8 years, including 285 males and 317 females. The majority are of Han ethnicity (93.63%), married (67.4%), and have undergone dialysis for less than 2 years (51.8%). A small segment (2%) lacks health insurance, paying for medical costs themselves, illustrating the study’s demographic diversity and clinical profiles.

Table 2. Symptom prevalence, distress, severity, and frequency in PD patients (N = 602).

Symptoms	Prevalence (%)	Distress (mean ± SD)	Severity (mean ± SD)	Frequency (mean ± SD)
Constipation	20.93%	0.81 ± 1.93	0.87 ± 2.02	0.90 ± 2.12
Nausea	25.08%	1.05 ± 2.17	1.21 ± 2.23	1.16 ± 2.34
Vomiting	24.92%	0.90 ± 1.70	0.87 ± 1.67	1.02 ± 1.98
Diarrhea	13.62%	0.43 ± 1.42	0.49 ± 1.53	0.51 ± 1.62
Decreased appetite	26.74%	1.30 ± 2.54	1.30 ± 2.52	1.29 ± 2.50
Muscle cramps	21.43%	0.95 ± 2.15	1.03 ± 2.26	1.00 ± 2.19
Swelling in legs	23.09%	0.91 ± 2.02	0.99 ± 2.10	1.08 ± 2.31
Dizziness	18.27%	0.77 ± 1.98	0.81 ± 2.01	0.75 ± 1.87
Restless legs	22.76%	1.02 ± 2.22	1.09 ± 2.31	1.05 ± 2.24
Numbness or tingling in feet	17.94%	0.82 ± 2.10	0.85 ± 2.10	0.86 ± 2.16
Feeling tired or lack of energy	35.38%	1.62 ± 2.64	1.66 ± 2.67	1.70 ± 2.71
Cough	30.07%	1.25 ± 2.34	1.32 ± 2.37	1.40 ± 2.50
Dry mouth	22.09%	0.93 ± 2.09	1.02 ± 2.22	1.05 ± 2.27
Bone or joint pain	24.42%	1.06 ± 2.23	1.01 ± 2.29	1.12 ± 2.31
Headache	10.63%	0.48 ± 1.63	0.46 ± 1.52	0.49 ± 1.62
Muscle soreness	13.62%	0.56 ± 1.72	0.58 ± 1.72	0.60 ± 1.78
Difficulty concentrating	11.79%	0.56 ± 1.71	0.57 ± 1.70	0.53 ± 1.59
Dry skin	40.37%	1.83 ± 2.69	2.00 ± 2.84	2.08 ± 2.93
Itching	38.54%	1.81 ± 2.81	1.89 ± 2.83	2.05 ± 3.03
Worrying	25.58%	1.14 ± 2.28	1.61 ± 2.37	1.13 ± 2.26
Trouble falling asleep	31.89%	1.85 ± 3.08	1.84 ± 3.03	1.89 ± 3.13
Trouble staying asleep	34.22%	1.46 ± 2.83	1.82 ± 2.95	1.82 ± 2.96
Feeling irritable	26.08%	1.06 ± 2.15	1.06 ± 2.16	1.11 ± 2.18
Feeling sad	18.44%	0.97 ± 2.39	0.95 ± 2.32	0.93 ± 2.30
Feeling anxious	23.09%	1.00 ± 2.20	1.03 ± 2.20	1.04 ± 2.21
Depression	11.13%	0.59 ± 1.93	0.61 ± 1.92	0.58 ± 1.88
Decreased interest in sex	38.70%	1.96 ± 3.04	2.25 ± 3.30	2.35 ± 3.42
Difficulty become sexual aroused	38.21%	1.96 ± 2.98	2.26 ± 3.26	2.38 ± 3.44

SD: standard error.

Within the Chronic Kidney Disease-Symptom Burden Index, ‘frequency’ is measured as the occurrence frequency of a symptom within a given timeframe. ‘Severity’ gauges the symptom’s intensity, categorized into mild, moderate, or severe levels. ‘Distress’ measures the emotional or psychological discomfort caused by a symptom. A higher score on any symptom item suggests a greater frequency, severity, and distress level, highlighting an increased burden of symptoms.

Table 3. Factor loading of total symptom score in PD patients (N = 602).

Symptom	Body symptom cluster	Gastro-intestinal symptom cluster	Mood symptom cluster	Sexual disorder symptom cluster	Skin and sleep symptom cluster
Nausea		0.91
Vomiting		0.91
Decreased appetite		0.57
Muscle cramps	0.62
Restless legs	0.56
Numbness or tingling in feet	0.67
Feeling tired or lack of energy	0.64
Bone or joint pain	0.64
Headache
Muscle soreness	0.61
Difficulty concentrating	0.65
Dry skin					0.50
Itching					0.45
Worrying			0.83
Trouble falling asleep					0.88
Trouble staying asleep					0.82
Feeling irritable			0.80
Feeling sad			0.88
Feeling anxious			0.86
Depression			0.83
Decreased interest in sex				0.95
Difficulty become sexual aroused				0.95
Eigenvalue	2.42	1.76	6.98	1.25	1.63
Variance contribution rate (%)	11.00	8.00	31.71	5.68	7.43
Cumulative variance contribution rate (%)	42.71	50.71	31.71	63.82	58.14

This table displays the principal component analysis outcomes for 22 symptoms in PD patients, categorizing them into five clusters: body, gastro-intestinal, mood, sexual disorder, and skin and sleep symptom clusters. These clusters reflect the symptom patterns and their contribution to the overall symptom burden, with a total variance contribution rate of 63.82%. This indicates the extent to which these clusters capture the diverse symptomatology in PD patients, facilitating targeted therapeutic strategies.

Figure 1. Network relationship map of symptoms in PD patients. This figure illustrates the network of 22 symptom connections in PD patients, highlighting significant relationships: a strong link between decreased sexual interest and arousal difficulties, foam urine’s strong tie to nocturia and moderate association with itching and dry skin, facial edema’s moderate link to leg swelling, and the moderate connection between frequent waking and sleep initiation troubles. This map offers a concise overview of symptom interactions in PD.

Figure 2. Centrality analysis of symptoms in PD patients. The figure illustrates centrality analysis results for PD, pinpointing decreased interest in sex and difficulty becoming sexually aroused as the most central and influential symptoms based on strength. These key symptoms are highlighted for their significant roles within the network, marked by high weights and strong influence.

Figure 3. Bootstrap analysis results of the edge weights. This figure displays bootstrap analysis results of network in PD patients, with the red line showing sample values and the gray area indicating bootstrapped confidence intervals. The consistent narrow CIs across all edges, ordered by weight, confirm the accuracy of the network’s structure.

Figure 4. Correlation stability coefficient of symptom network in PD patients. The figure presents the PD symptom network’s stability, with strength correlation coefficients consistently above 0.5, affirming network reliability. It also shows strength centrality’s superior stability over closeness and betweenness measures.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.