{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T10:16:02Z","timestamp":1790504162594,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2016,5,20]],"date-time":"2016-05-20T00:00:00Z","timestamp":1463702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Advanced Nursing"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To explore the existence of symptom clusters in advanced chronic kidney disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>People with chronic kidney disease commonly report multiple symptoms. However, the complex relationships among these symptoms are still poorly understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross\u2010sectional.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 436 people with stage 4 and 5 chronic kidney disease were recruited from three tertiary hospitals during 2013\u20132014. Participants completed the Chronic Kidney Disease\u2013Symptom Burden Index that assesses four symptom dimensions (occurrence, distress, severity and frequency) of 32 symptoms. Exploratory factor analysis was used to identify symptom clusters across each symptom dimension. Core symptoms in each cluster were determined based on stability across dimensions and clinical plausibility. A high cutoff of 0\u00b750 for factor loading was used for all analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five symptom clusters were consistently identified across all symptom dimensions: fluid volume symptoms, neuromuscular symptoms, gastrointestinal symptoms, sexual symptoms and psychological symptoms. Overall, clusters ranged from 2\u201010 symptoms. Several symptoms were also interconnected with multiple clusters. Fatigue cross\u2010loaded on all five clusters, whereas sleep disturbance and restless leg symptoms cross\u2010loaded across three clusters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adopting a symptom cluster approach has the potential to significantly advance symptom assessment and nursing care for people in advanced stages of chronic kidney disease. Routine clinical assessment and management strategies targeted at the cluster level should have synergistic effects in reducing symptoms. Fatigue is a pervasive symptom in advanced chronic kidney disease that is interconnected with global symptom burden, suggesting better management of symptom clusters may also reduce fatigue.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jan.12997","type":"journal-article","created":{"date-parts":[[2016,5,21]],"date-time":"2016-05-21T21:48:36Z","timestamp":1463867316000},"page":"2389-2400","source":"Crossref","is-referenced-by-count":60,"title":["Multidimensional symptom clusters: an exploratory factor analysis in advanced chronic kidney disease"],"prefix":"10.1111","volume":"72","author":[{"given":"Hayfa","family":"Almutary","sequence":"first","affiliation":[{"name":"School of Nursing Queensland University of Technology Brisbane Queensland Australia"},{"name":"School of Nursing King Abdulaziz University Jeddah Saudi Arabia"},{"name":"Chronic Kidney Disease Centre for Research Excellence University of Queensland Brisbane Queensland 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