Background and objectiveFatigue is frequently experienced by patients undergoing hemodialysis and it has a negative effect on their quality of life. The aim of this study was to investigate the factors associated with fatigue in patients undergoing hemodialysis. MethodsIn this quantitative cross-sectional study, 100 patients on hemodialysis participated. Fatigue was evaluated via the Modified Fatigue Impact Scale (MFIS). Participants also completed a questionnaire about demographics and clinical characteristics. The Kruskal-Wallis test, the Mann-Whitney U test, and Spearman's rho criterion were used to assess the association between fatigue score and patient characteristics. Multiple linear regression was performed to assess the effect of the characteristics on patients' fatigue. ResultsStatistically significant high levels of physical or mental fatigue were found in older patients (p=0.001 and p=0.001), divorced/widowed patients (p=0.001 and p=0.014), those who had children (p=0.019), those who had primary education (p=0.015), those who were not informed about their health problems (p=0.003 and p=0.006), those who had comorbid diseases (p=0.001 and p=0.001), those who believed that regular information did not help to reduce stress (p=0.005 and p=0.004), patients who had insomnia (p=0.001 and p=0.001), patients who felt tired after hemodialysis (p=0.001 and p=0.001), those who thought they had a change in body image (p=0.001 and p=0.001), those who often felt stiffness (p=0.001 and p=0.001), those who sometimes felt nausea (p=0.015 and p=0.038), and those who had limitations in the clothes they could wear (p=0.001 and p=0.001). ConclusionsThe findings of this study showed that physical or mental fatigue had a strong association with advanced age, comorbidities, marital status, level of education, inadequate information about the disease, insomnia, and change in body appearance. Hence, renal professionals need to properly educate dialysis patients on the complicated nature of fatigue in order to manage it effectively and improve their physical, cognitive, and social wellbeing.

Introduction: Depression is a commonly experienced psychological disorder among patients undergoing hemodialysis and has a strong association with insomnia and fatigue. The purpose of the present study was to explore the factors related to depression in dialysis patients and the impact of insomnia and fatigue on depression. Methods: In this cross-sectional study, one hundred (n=100) patients on hemodialysis from one hemodialysis center in Greece participated. Data collection was carried out by interviews using the Zung Self-rating Depression Scale (SDS) for the evaluation of depression; the Athens Insomnia Scale (AIS) for the evaluation of insomnia; the Modified Fatigue Impact Scale (MFIS) for the evaluation of fatigue; and a questionnaire which was created by the researchers. The Kruskal-Wallis, the Mann-Whitney tests, and the Spearman's rho criterion were used to evaluate the relationship between depression score and patient characteristics. Multiple linear regression was performed to assess the effect of characteristics on patients' depression. Results: Statistically significantly high levels of depression were found in patients over the age of 70 years old (p=0.001), in divorced/widowed patients (p = 0.001), in pensioners (p = 0.002), in patients who had other diseases (p = 0.001), in those who felt tired after hemodialysis or at night and those who felt constantly tired (p = 0.001, p = 0.016, and p = 0.001, respectively), in those who had physical and mental fatigue (p = 0.001 and p = 0.001, respectively), in those who had changes in body image (p = 0.009), itching, stiffness, and nausea/vomiting (p = 0.001, p = 0.001, and p = 0.003, respectively), in patients who had restrictions in clothes they could wear (p = 0.001), in patients who had insomnia (p = 0.001), and in patients who did not wish to receive written information about the management of their disease (p = 0.025). A statistically significant positive linear association was detected between physical/mental fatigue and depression levels (rho = 0.824 and rho = 0.746, respectively) and between the score of insomnia and depression levels (rho = 0.707). An increase in fatigue (either physical or mental) and an increase in insomnia score also indicated an increase in depression levels. Conclusions: The findings of this study showed that depression had a strong association with a variety of demographic factors. Additionally, an increase in fatigue score and an increase in insomnia score indicated an increase in depression levels. Therefore, depression, insomnia, and fatigue should be early assessed and effectively treated by renal professionals in order to improve the quality of life in hemodialysis patients and reduce their morbidity and mortality.