Symptom Monitoring With Feedback Trial (SWIFT)

Overview

SWIFT, the Sympton Monitoring with Feedback Trial, is a large registry-embedded clinical trial testing whether regular symptom monitoring, with feedback to dialysis clinicians, can improve outcomes for people on haemodialysis. It is the first cluster-randomised, registry-based controlled trial run by the NHMRC Clinical Trials Centre (CTC) based at the University of Sydney in collaboration with ANZDATA.

The trial compares three-monthly symptom monitoring with standard care (no routine monitoring) to assess whether it improves patient outcomes at 12 months, reduces unplanned hospitalisations, and supports better care. Open to adults on chronic haemodialysis in Australia and New Zealand, SWIFT is funded by the NHMRC and is currently recruiting across multiple dialysis units.

Principal Investigators:	Rachael L Morton, Stephen McDonald, Chris Brown, Paul Bennett, Fergus Caskey, Cecile Couchoud, Shilpa Jesudason, Andrea Viecelli, Brendan Smyth and William Handke (consumer)
Project Manager:	Nicola Barrie, NHMRC Clinical Trials Centre, University of Sydney
Clinical Trial Coordinator:	Dana Alhuzaimi, ANZDATA Registry, SAHMRI
Trial Operations Cordinator:	Prena Nasikkar, NHMRC Clinical Trials Centre, University of Sydney
Trial Onsite Support:	Julian Chung, Research Assistant, NHMRC CTC Alexandra Picorelli, Research Assistant (SWIFT), ANZDATA Registry, SAHMRI
Trial Registration Number:	ACTRN12620001061921
Population:	Adults aged 18 years and older with ESKD receiving in-centre haemodialysis or haemodiafiltration in Australia and New Zealand
Intervention:	Both the EQ-5D-5L (5 questions and Visual Analogue Scale) and IPOS-Renal measures (11 Questions) will be collected by patients using a tablet when they come for their in-centre dialysis sessions
Follow-up:	1 year
Primary outcome:	Change in health-related quality of life (measured by validated and widely used EQ-5D-5L questionnaire)
Status:	Recruitment Closed
Latest Output:	The Symptom Monitoring with Feedback Trial (SWIFT): protocol for a registry-based cluster randomised controlled trial in haemodialysis

Research Team

Prof Rachael Morton

Chief Investigator, Director, Health Economics & Health Technology Assessment at the NHMRC Clinical Trials Centre

Prof Stephen McDonald AM

Clinical Lead, Senior Staff Nephrologist RAH, Clinical Director of Renal Services for Country Health SA, Director of Strategy and Policy & Executive Officer of ANZDATA

Barrie, N

Project Manager, NHMRC Clinical Trials Centre

Prena Nasikkar

Trial Operations Coordinator, NHMRC Clinical Trials Centre

Dana Alhuzaimi

Clinical Trial Coordinator, ANZDATA Registry

Julian Chung

Research Assistant, New South Wales

Alexandra Picorelli

Research Assistant, Queensland

Background

People receiving haemodialysis for kidney failure often experience a heavy symptom burden. Common issues like tiredness, pain, itching, sleep problems, and depression significantly reduce quality of life.¹ On average, people on dialysis report feeling at only 60% of full health. Long-term survival is poor: only about half of patients remain on dialysis after five years, which is worse than survival rates for all cancers combined.²

Haemodialysis is also a major health system cost, with around 13,000 Australians on treatment and annual costs of $1.1 billion nationwide.

Despite this, standard dialysis care tends to focus on managing blood levels of urea, potassium, and phosphate, rather than addressing the symptoms that matter most to patients. This has led to missed opportunities to improve both quality of life and survival. Emerging evidence suggests that regular symptom monitoring can help improve both.

SWIFT – the Symptom monitoring WIth Feedback Trial – is testing this in haemodialysis patients. Led by Professor Rachael Morton (University of Sydney and NHMRC Clinical Trials Centre) and ANZDATA, SWIFT is investigating whether regular symptom monitoring with clinician feedback can improve patient outcomes.

Common Symptoms in Haemodialysis Patients

Symptoms haemodialysis patients experience	Percentage of people with symptom (%)
tiredness	71%
itching	55%
constipation	53%
anorexia	49%
pain	47%
sleep problems	44%

References:

¹ Murtagh FE et al. Adv Chronic Kidney Dis. 2007;14(1):82-99;

² Basch E et al. JAMA. 2017;318(2):197-198.

Study Aim

SWIFT aims to determine whether regular symptom monitoring, with feedback provided to nurses, kidney specialists, and patients, improves health-related quality of life for people receiving haemodialysis. The study will also assess whether collecting symptom information using tablet-based surveys is a cost-effective approach to care.

Study Groups

Participating dialysis units are allocated to one of two groups. In both groups, participants complete surveys using a tablet computer during dialysis sessions.

Group 1 – Control Arm

Participants complete the EQ-5D-5L and SONG-HD Fatigue surveys every six months for one year. Each survey set takes approximately five minutes. At the 12-month mark, a sample of participants may be invited to provide feedback on their experience in the trial.

Group 2 – Intervention Arm

Participants complete the IPOS-Renal symptom survey every three months, along with the EQ-5D-5L and SONG-HD Fatigue surveys every six months. Each survey session takes approximately ten minutes. Completed IPOS-Renal surveys are shared with dialysis nurses and treating kidney doctors, who are asked to review and follow up on reported symptoms at the next appointment. At 12 months, a sample of participants may also be invited to provide feedback on the trial.