Fatigue in incident peritoneal dialysis and mortality: A real-world side-by-side study in Brazil and the United States

Abstract

Background We tested if fatigue in incident Peritoneal Dialysis associated with an increased risk for mortality, independently from main confounders. Methods We conducted a side-by-side study from two of incident PD patients in Brazil and the United States. We used the same code to independently analyze data in both countries during 2004 to 2011. We included data from adults who completed KDQOL-SF vitality subscale within 90 days after starting PD. Vitality score was categorized in four groups: >50 (high vitality), ≥40 to ≤50 (moderate vitality), >35 to <40 (moderate fatigue), ≤35 (high fatigue; reference group). In each country’s cohort, we built four distinct models to estimate the associations between vitality (exposure) and all-cause mortality (outcome): (i) Cox regression model; (ii) competing risk model accounting for technique failure events; (iii) multilevel survival model of clinic-level clusters; (iv) multivariate regression model with smoothing splines treating vitality as a continuous measure. Analyses were adjusted for age, comorbidities, PD modality, hemoglobin, and albumin. A mixed-effects meta-analysis was used to pool hazard ratios (HRs) from both cohorts to model mortality risk for each 10-unit increase in vitality. Results We used data from 4,285 PD patients (Brazil n = 1,388 and United States n = 2,897). Model estimates showed lower vitality levels within 90 days of starting PD were associated with a higher risk of mortality, which was consistent in Brazil and the United States cohorts. In the multivariate survival model, each 10-unit increase in vitality score was associated with lower risk of all-cause mortality in both cohorts (Brazil HR = 0.79 [95%CI 0.70 to 0.90] and United States HR = 0.90 [95%CI 0.88 to 0.93], pooled HR = 0.86 [95%CI 0.75 to 0.98]). Results for all models provided consistent effect estimates. Conclusions Among patients in Brazil and the United States, lower vitality score in the initial months of PD was independently associated with all-cause mortality.

Exploring symptom clusters in Chinese patients with peritoneal dialysis: a network analysis

“…In our study, fatigue was reported by 35.38% of participants, a prevalence significantly lower than the 70–78% reported in other studies [ 14 , 57 ]. This discrepancy in fatigue rates may be attributed to various factors, including sleep quality, nutritional status, and depression of patients [ 58 , 59 ]. Nonetheless, our symptom network analysis identified fatigue as a core symptom in PD patients, aligning with previous findings [ 60 ].…”

“…Anxiety might worsen prognosis by affecting health behaviors or altering physiological pathways, such as increasing norepinephrine levels, which can reduce peritoneal ion permeability and potentially lead to PD technique failure [ 62 ]. Both fatigue and anxiety are linked to decreased HRQoL and increased hospitalization and mortality rates [ 59 , 61 , 63 ]. Core symptoms, as opposed to marginal ones, are believed to have a greater overall impact on patient well-being [ 56 ].…”

Prevalence and influencing factors of fatigue among patients undergoing continuous ambulatory peritoneal dialysis: A cross-sectional study

“…Feeling fatigued restricts patients with CAPD from maintaining self-care routines, effectively managing their diet, or participating in social activities (van der Borg et al, 2021 ). Importantly, fatigue significantly predicts the mortality rate and increases the number of deaths (Guedes et al, 2022 ; James et al, 2020 ).…”