{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T06:25:30Z","timestamp":1785824730049,"version":"3.56.0"},"reference-count":75,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,4,25]],"date-time":"2017-04-25T00:00:00Z","timestamp":1493078400000},"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":[[2017,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>The aim of this study was to test a symptom cluster model in chronic kidney disease patients based on the Theory of Unpleasant Symptoms, accounting for the relationships between influencing factors, symptom experience and consequences for quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>The evaluation of symptom clusters is a new field of scientific inquiry directed towards more focused symptom management. Yet, little is known about relationships between symptom clusters, predictors and the synergistic effect of multiple symptoms on outcomes.<\/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>Data were collected from 436 patients with advanced stages of chronic kidney disease during July 2013\u2013February 2014 using validated measures of symptom burden and quality of life. Analysis involved structural equation modelling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The final model demonstrated good fit with the data and provided strong evidence for the predicted relationships. Psychological distress, stage of chronic kidney disease and age explained most of the variance in symptom experience. Symptom clusters had a strong negative effect on quality of life, with fatigue, sexual symptoms and restless legs being the strongest predictors. Overall, the model explained more than half of the deterioration in quality of life. However, a reciprocal path between quality of life and symptom experience was not found.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Interventions targeting symptom clusters could greatly improve quality of life in patients with chronic kidney disease. The symptom cluster model presented has important clinical and heuristic implications, serving as a framework to encourage and guide new lines of intervention research to reduce symptom burden in chronic kidney disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jan.13303","type":"journal-article","created":{"date-parts":[[2017,3,23]],"date-time":"2017-03-23T13:06:44Z","timestamp":1490274404000},"page":"2450-2461","source":"Crossref","is-referenced-by-count":63,"title":["Towards a symptom cluster model in chronic kidney disease: A structural equation\u00a0approach"],"prefix":"10.1111","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9650-9068","authenticated-orcid":false,"given":"Hayfa","family":"Almutary","sequence":"first","affiliation":[{"name":"School of Nursing Queensland University of Technology Brisbane Qld Australia"},{"name":"School of Nursing King Abdulaziz University Jeddah Saudi Arabia"},{"name":"Chronic Kidney Disease Centre for Research Excellence University of Queensland Brisbane Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clint","family":"Douglas","sequence":"additional","affiliation":[{"name":"School of Nursing Queensland University of Technology Brisbane Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Bonner","sequence":"additional","affiliation":[{"name":"School of Nursing Queensland University of Technology Brisbane Qld Australia"},{"name":"Chronic Kidney Disease Centre for Research Excellence University of Queensland Brisbane Qld Australia"},{"name":"Renal Medicine Royal Brisbane and Women's Hospital Brisbane Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,4,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2369-13-170"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.00430109"},{"issue":"3","key":"e_1_2_10_4_1","first-page":"125","article-title":"A study of quality of life and its determinants among hemodialysis patients using the KDQOL\u2010SF instrument in one center in Saudi Arabia","volume":"4","author":"Al Jumaih A.","year":"2011","journal-title":"Arab Journal of Nephrology and Transplantation"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-6686.2013.12022.x"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-015-0036-2"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jorc.12152"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.12997"},{"issue":"4","key":"e_1_2_10_9_1","first-page":"339","article-title":"End stage chronic kidney disease in Saudi Arabia. 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