Chronic kidney disease (CKD) is often unpredictable, and patients may not feel ill as the disease progresses to end stage renal disease (ESRD), an illness that affects over 593,000 people in the United States (United States Renal Data System [USRDS], 2012), and requires dialysis (hemodialysis or peritoneal dialysis) or kidney transplant. Patients on hemodialysis account for approximately 92% of the overall dialysis population (USRDS, 2012) and endure a high symptom burden. They may experience troubling symptoms, such as fatigue, decreased appetite, trouble concentrating, swelling in their feet and hands, muscle cramps, and itching (Almeras & Argiles, 2009; Murtagh, Addington-Hall, & Higginson, 2007; Yong et al, 2009), all of which cause daily distress and negatively affect their quality of life (Jablonski, 2007; Kimmel, Emont, Newmann, Danko, & Moss, 2003; Weisbord et al., 2005).
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