Development of the Chronic Kidney Disease Symptom Index – Sri Lanka; a symptom assessment instrument for Chronic Kidney Disease patients

Background & Objective
An assessment of the symptom burden of chronic kidney disease (CKD) patients is very important in clinical management.  A comprehensive validated questionnaire designed specifically for the assessment of symptoms in CKD patients is lacking in the local context.  Such an instrument could be used for research purposes and as a tool to improve the care of patients.  Thus, in the present study, a tool was developed to assess the presence and severity of symptoms experienced by CKD patients

Method
Development of the Chronic Kidney Disease Symptom Index – Sri Lanka (CKDSI – Sri Lanka) followed a step wise process.  Identifying the items, identifying overlapping symptoms, reducing the items, identifying the appropriate time duration to inquire,  reaching for a consensus on a method to quantify the symptom burden,  translation, pre testing, assessment of discriminant and convergent validity and reliability assessment were the steps followed.

Results
Two hundred and fifty adults participated in the study. The mean age of the sample was 57.7 years (SD 10.6).  A majority (71.6%) were in either category three or category four CKD. Compared to the study population without any long term comorbid conditions, presence of comorbidities was found to be statistically significantly associated with high median scores of symptom burden (p<0.001) Symptom burden scores significantly correlated with CKD stage (r = 0.357). These denote satisfactory discriminant validity of the instrument.  Domains of KDQOL-SF correlated negatively with the symptom burden which confirmed convergent validity. The Spearman’s r value was more than 0.9 which indicates perfect test retest reliability.

Conclusions
The CKDSI-Sri Lanka showed good psychometric properties and is suitable to assess symptom burden in different CKD populations. Thus this instrument could be used for research purposes and as a tool to improve patient care.

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