Abstract: Objective  To explore the interrelationships among symptom clusters in maintenance hemodialysis (MHD) patients and to identify bridge symptoms among the symptom clusters.  Methods   A total of 480 MHD patients were selected using convenience sampling method. They were investigated by utilizing the dialysis symptom index scale. The network analysis was used to identify bridge symptoms among symptom clusters.  Results  The MHD patients experienced six symptom clusters, namely uremia symptom cluster, gastrointestinal symptom cluster, emotional symptom cluster, skin symptom cluster, water electrolyte symptom cluster, and sexual dysfunction symptom cluster. According to the index of bridge centrality, worrying (rbs=7.946) and dry skin (rbs=7.800) had the highest bridge strength; worrying (rbc=0.331) and feeling sad (rbc=0.322) had the highest bridge closeness; decreased interest in sex (rbb=12.000) and trouble falling asleep (rbb=7.000) had the highest bridge betweenness.  Conclusion  MHD patients are troubled by multiple symptom clusters. Worrying and dry skin are bridge symptoms among different symptom clusters. Accurate intervention of bridge symptoms is beneficial to block the bridging effect between different symptom clusters and improve the efficiency of symptom management.

Key words: Maintenance hemodialysis, Symptom cluster, Bridge symptom, Network analysis