Turkish psychometric properties of the hemodialysis symptom distress scale: A Prospective Cross-Sectional Study

For millions of people around the world, the kidneys have stopped working well enough to keep the body clean. When this happens, a machine must take over the job of filtering waste from the blood, a process known as hemodialysis. While this treatment keeps patients alive, it is not without its own heavy toll. The hours spent connected to the machine, combined with the underlying disease, often bring a flood of uncomfortable feelings: aching muscles, nausea, trouble sleeping, and a deep, draining fatigue. These symptoms do not always arrive alone; they tend to group together, forming clusters that can make daily life feel overwhelming. To help doctors and nurses manage this burden, they need a way to measure exactly how much these symptoms are bothering a patient. Without a reliable tool to listen to the patient's experience, it is difficult to know which treatments will truly help or how to improve the quality of life for someone undergoing this demanding therapy.

In a recent study conducted in Turkey, researchers set out to test a specific tool designed to listen to these patients. The tool is called the Hemodialysis Symptom Distress Scale, a questionnaire that asks patients to rate how often they feel various physical and emotional troubles and how much those troubles upset them. The original version of this scale was created in English, but the researchers wanted to know if it would work just as well for Turkish speakers. They needed to be sure that the questions made sense in a new language and that the scale could accurately capture the unique mix of symptoms Turkish patients experience. To find the answer, they gathered a group of 200 patients from three public hospitals in the southeastern part of the country. These were individuals who had been on dialysis for at least six months, were over eighteen years old, and were willing to share their experiences openly.

The researchers began by carefully translating the scale from English into Turkish, ensuring that every word carried the same meaning. They then asked a panel of medical experts to review the questions, checking to see if the items were clear and relevant to the lives of dialysis patients. Once the Turkish version was finalized, the team asked the 200 patients to fill it out. To be certain the scale was measuring what it was supposed to measure, the researchers used a statistical method to see how the answers grouped together. They were looking to see if the symptoms naturally fell into specific categories, or clusters, rather than appearing as a random list of complaints. The analysis revealed that the scale worked very well, but with a small adjustment. Two of the original questions, which asked about sore muscles and a lack of energy, did not fit neatly into the groups the other questions formed. Because these two items did not align with the rest of the pattern, the researchers removed them, leaving a streamlined version of the test with twenty questions.

This new twenty-question version, which the researchers call the HSD-20, organized the symptoms into four clear groups. The first and largest group captured a wide range of issues related to sleep and general discomfort, including trouble falling asleep, waking up at night, itchy skin, and feelings of dizziness or numbness. The second group focused on problems with the heart and lungs, such as chest pain, shortness of breath, and a tight feeling in the chest. The third group gathered symptoms of exhaustion, including a lack of vitality, muscle weakness, and a dry mouth. The final group dealt with digestive troubles, specifically a loss of appetite, nausea, and vomiting. Together, these four groups explained more than half of the variation in how patients felt, showing that the scale successfully captured the main ways these patients experience distress.

To ensure the scale was trustworthy, the researchers checked its consistency in several ways. They asked the patients to fill out the survey again two to four weeks later to see if their answers remained stable over time. The results showed a very strong agreement between the first and second attempts, indicating that the scale measures the same thing reliably. They also checked how well the questions agreed with each other within the test itself, finding that the internal consistency was high. Furthermore, they compared the results of this new scale with another well-known tool used to measure dialysis symptoms. The two tools agreed with each other strongly, suggesting that the Turkish version was measuring the same real-world experiences as the established methods.

The study concludes that this Turkish version of the Hemodialysis Symptom Distress Scale is a solid and reliable tool for healthcare providers. It offers a clear way to identify the specific clusters of symptoms that Turkish patients face, from the fatigue that weighs them down to the chest pain that frightens them. By using this scale, nurses and doctors can better understand the full picture of a patient's suffering, moving beyond just treating the kidney failure to addressing the daily discomfort that comes with it. This understanding is the first step toward creating better care plans that can truly improve the lives of those who depend on dialysis to survive.