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Improving Hemodialysis-Related Symptoms

What challenge are we trying to solve?

Hemodialysis is a life-saving treatment but often causes distressing symptoms. People treated with hemodialysis frequently report symptoms such as muscle cramps, itching, and fatigue, and these symptoms contribute to poor quality of life and hospitalizations. Research in patients with other chronic diseases show that frequently asking patients to report their symptoms using standardized questionnaires (patient-reported outcome measures) and helping medical providers follow up on reported symptoms can improve symptoms, quality of life, and health care use. In current hemodialysis practice in the United States, patients formally report their symptoms once a year on a quality of life survey, and there is no system to help medical providers follow up on the reported symptoms.

“You have to take control of your own treatment, and [symptom monitoring] is the first step to doing that. You can’t expect to feel better unless you tell them that you’re feeling bad, because if they don’t know then, they can’t fix it.”


“When I got home from dialysis, I would have to sleep for a few hours before I could function. But that whole day was really done. After that, I could go about my chores or do what I had to do – but the next day, I would have to go through it all over again. So, it really sucks up your whole life.

SMaRRT-HD Study Overview

SMaRRT-HD logoThe SMaRRT-HD Study, also known as “Comparative Effectiveness of Two Approaches to Symptom Monitoring in Hemodialysis” compares two approaches for monitoring and addressing symptoms among adult patients with kidney failure who are treated with hemodialysis. For the first approach patients use an electronic system (called SMaRRT-HD) twice a month to report their symptoms. The system sends alerts to their medical team at the dialysis clinic about the reported symptoms and gives suggestions about how to manage them. The system also provides reports that show patients and their medical team the reported symptoms over time. For the second approach patients complete a quality of life questionnaire that includes questions about symptoms once a year. The questionnaire does not have follow-up support like alerts, symptom management guidance, or reports. In addition, researchers will talk to patients, dialysis clinic personnel, and medical providers about their experiences using the electronic symptom monitoring system to learn about how to best use patient-reported outcome measures in dialysis care.

Study Design Overview 


  • Patients and care partners
  • Dialysis organization leaders
  • Interdisciplinary care team representatives
  • Policymakers
  • Professional and patient organizations

SMaRRT-HD Development

Research Capacity

  • Coming soon

Patient-Centered Outcomes Research Institute (PCORI) Research Award (IHS-2021C2-23534)


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