In 2025, Guerraoui et al. published the Concordance Study in Clinical Kidney Journal, a large multicenter cross-sectional study embedded within the French REIN registry. This study compared symptoms reported by hemodialysis patients using the Dialysis Symptom Index (DSI) with clinician-perceived symptoms, revealing a high symptom burden and marked patient-clinician discordance [3].

The present work is a secondary analysis of the Concordance Study dataset. Building on the original findings, this analysis aims to deepen understanding of symptom organization and determinants in hemodialysis using multivariate and correlation-based approaches. Specifically, our objectives were :

1. to identify and characterize symptom clusters using tetrachoric correlations and hierarchical clustering;
2. to examine associations between symptoms (and clusters) and comorbidity burden, while assessing potential sex-specific patterns in symptom expression.

Through this secondary analysis, we aim to clarify the internal architecture of symptom co-occurrence, identify key demographic drivers such as sex, and generate evidence supporting cluster-informed, individualized approaches to symptom assessment and management in routine nephrology care.

Inclusion Criteria:

• undergoing maintenance hemodialysis
• ≥18 years
• dialysis vintage ≥3 months

Exclusion Criteria:

• patients with cognitive impairment (which was assessed with the presence of either clinical judgement or formal diagnosis)
• patients who did not have the ability to express consent or refused to participant in the study
• patients who could not read or understand French well enough to complete the questionnaire.

Hemodialysis patients in six dialysis centres and self-dialysis units in the Rhône-Alpes region of France

all IPD collected

Beginning 3 months and ending 3 years after the publication of results