Fatigue in Patients Receiving Maintenance Dialysis: A Review of Definitions, Measures, and Contributing Factors

Abstract

Fatigue is a debilitating symptom or side effect experienced by many patients on long-term dialysis. Fatigue has a considerable effect on patients' health-related quality of life and is viewed as being more important than survival by some patients. There are many challenges renal providers face when attempting to reduce fatigue in dialysis patients. The lack of a reliable, valid, and sensitive fatigue scale complicates the accurate identification of this symptom. Symptoms of daytime sleepiness and depression overlap with fatigue, making it difficult to target specific therapies. Moreover, many chronic health conditions common in the long-term dialysis population may lead to the development of fatigue and contribute to the day-to-day and diurnal variation of fatigue in patients. Key to improving the assessment and treatment of fatigue is improving our understanding of potential mediators, as well as potential therapies. Cytokines have emerged as an important mediator of fatigue and have been studied extensively in cancer related fatigue. In addition, although erythropoietin stimulating agents (ESA) have been shown to mitigate fatigue, the recent controversy regarding ESA dosing in chronic kidney disease (CKD) suggests that ESA therapy may not serve as the sole therapy to improve fatigue in this population. In conclusion, fatigue is an important and often underrecognized symptom in the dialysis population. Possible interventions for minimizing fatigue in patients on long-term dialysis should be aimed at improving health care provider awareness, developing improved methods of measurement, better understanding of the pathogenesis, as well as management of known contributing factors.

Factors related to fatigue in Chinese patients with end-stage renal disease receiving maintenance hemodialysis: a multi-center cross-sectional study

“…The average fatigue level among these patients of 39 (31-44) was worse than in the general population (t¼-6.89, p50.001) and better than the nondialysis-dependent CKD (t¼5.07, p50.001) and ESRD (t¼4.09, p50.001) patients in US. As in other chronic diseases, fatigue is associated with poor quality of life in patients with hemodialysis 7,31 ; it is also a vital predictor of cardiovascular disease. Despite the high prevalence of fatigue and its impact on healthcare outcomes, little attention has been paid to it, let alone to developing widely useful treatment of it for MHD patients in mainland China.…”

“…These symptoms greatly interfere with patients' quality of life. [6][7][8][9] Fatigue is one of the most common symptoms experienced by patients with ESRD and it can be defined as weakness, exhaustion, incapacitating, and ailment. 10,11 Due to different race and the use of various fatigue measures, the prevalence of fatigue is estimated to range from 60 to 97% among the MHD patients.…”

“…10,11 Due to different race and the use of various fatigue measures, the prevalence of fatigue is estimated to range from 60 to 97% among the MHD patients. 7 Previous studies showed that fatigue has a greatly negative influence on patients' quality of life and has serious psychological, physiological, and socio-demographic implications for patients, families, and even the community 12,13 ; fatigue also showed significant associations with cardiovascular and suicidal risk, which substantially elevated hospitalization and mortality for the MHD patients.…”

“…Previous studies have indicated that the association between biochemical markers (i.e., HGB, p, Ca, Scr, Kt/V) and fatigue are inconsistent. 7 In this study, Kt/V was used to evaluate the adequacy of the dialysis dose, with a target minimum level of 1. 57 In our study, 38% of the MHD patients were above 60 and age was positively correlated with fatigue level.…”

Effect of intradialytic exercise on fatigue, electrolytes level and blood pressure in hemodialysis patients: A randomized controlled trial

“…Fatigue usually not identified adequately and thus under-treated. [13] Basically, fatigue represented as weakness, lack of energy and feeling of exhaustion. [7] Fatigue affects not only day life but also disturbed daily selfcare activities, emotional status, and therefore the quality of life.…”