Dynamic symptom network structure and core symptom identification in patients with end⁃stage kidney disease before and after dialysis

ObjectiveTo construct symptom networks in patients with end⁃stage kidney disease before and after dialysis and to explore the dynamic interactions among different symptoms over time.MethodsA total of 299 patients undergoing initial hemodialysis treatment at a tertiary grade A hospital in Sichuan province were selected as the study subjects from November 2024 to September 2025.Patients were surveyed using a self⁃designed general demographic questionnaire and an adapted version of the Dialysis Symptom Assessment Scale.A cross⁃lagged network model was employed to identify dynamic interactions among 18 symptoms over time.ResultsThe forward time⁃lagged correlation was sleep difficulty→itching(β=0.33).The backward time⁃lagged correlation was fatigue or lack of energy→sleep difficulty(β=-0.22).Sleep difficulty reported the greatest out⁃predictability(0.265),in⁃predictability(0.233),out⁃strength(1.498),and in⁃strength(1.591).ConclusionsSleep difficulty was identified as the core symptom of the dynamic network model of symptom before and after dialysis in patients with end⁃stage renal disease.Strategies to alleviate sleep difficulty should be incorporated into multimodal interventions for end⁃stage kidney disease.