Fatigue Is a Predictor for Cardiovascular Outcomes in Patients Undergoing Hemodialysis

Koyama, Hideki; Fukuda, Sanae; Shoji, Tetsuo; Inaba, Masaaki; Tsujimoto, Yoshihiro; Tabata, Tsutomu; Okuno, Senji; Yamakawa, Tomoyuki; Okada, Shigeki; Okamura, Mitsu; Kuratsune, Hirohiko; Fujii, Hisako; Hirayama, Yukio; Watanabe, Yasuyoshi; Nishizawà, Yoshiki

doi:10.2215/cjn.08151109

Cited by 101 publications

(83 citation statements)

References 42 publications

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“…Therefore, adequate management of fatigue would have a positive impact on MHD patients' healthcare outcomes and even survival. 14,32 With the prevalence ranged from 50 to 80%, sleep disorder is an extremely common problem among longterm renal replacement therapy patients. 33 These patients suffer from sleep abnormalities, such as insomnia, restless legs syndrome (RLS), obstructive sleep apnea syndrome (OSAS), and periodic limb movement disorder.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Zang

et al. 2016

Renal Failure

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Section: Discussionmentioning

confidence: 99%

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

Wang

Zang

et al. 2016

Renal Failure

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“…Fatigue is a complex and subjective symptom that has been described as extreme and persistent tiredness that cannot be alleviated by rest (Dittner, Wessely, & Brown, 2004). There is extensive evidence on its detrimental consequences on functioning and clinical outcomes (Artom et al ., 2014; Bonner, Caltabiano, & Berlund, 2013; Bossola et al ., 2015; Davison & Jhangri, 2010; Jhamb et al ., 2009, 2011; Koyama et al ., 2010). …”

Section: Introductionmentioning

confidence: 99%

‘It's when you're not doing too much you feel tired’: A qualitative exploration of fatigue in end‐stage kidney disease

Picariello

Moss‐Morris

Macdougall

et al. 2017

British J Health Psychol

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BackgroundFatigue is commonly experienced in end‐stage kidney disease (ESKD) patients. In order to develop patient‐centred psychosocial interventions to help patients manage fatigue symptoms, a more in‐depth understanding regarding the experience of fatigue is needed.ObjectiveThe objective of this study was to explore renal patients’ experiences of fatigue, across renal replacement therapy (RRT) modalities.MethodsTwenty‐five in‐depth semi‐structured interviews were conducted. Interviews were audio‐taped, transcribed, and analysed using inductive thematic analysis.ResultsMain themes included the strong role of the illness and treatment in the aetiology of fatigue. Two contrasting streams of illness–fatigue interpretations emerged: catastrophizing versus normalizing. Participants emphasized the importance of having a sense of purpose in facilitating active management of fatigue. Many participants described the consequences of fatigue on their functioning. Low mood, frustration, and anger were common emotional consequences of fatigue. Three dominant fatigue management strategies emerged: one related to accommodation of activities around fatigue, another on increasing activities to counteract fatigue, and the third one revolved around self‐compassion. Social support emerged as an important aspect of the fatigue experience, serving as a source of motivation, yet participants were wary of becoming a burden to others.ConclusionFindings identify casual attributions, behavioural and emotional reactions, management strategies, and facilitators of active management of fatigue in ESKD. Untying fatigue from the illness and treatment may help patients to develop alternative less catastrophic perceptions of fatigue, increase their perception of control over fatigue, and facilitate active fatigue management. Statement of contribution What is already known on this subject? Fatigue is persistent and debilitating in end‐stage kidney disease (ESKD), with no consistent treatment model.Promising evidence is available for psychological fatigue interventions in other chronic conditions.There is a gap in studies looking at the fatigue experiences of patients with ESKD across renal replacement therapies. What does this study add? Fatigue is not inherently negative, but shaped by patients’ beliefs and behaviours.Findings provide novel insights, for example, on the important role social support seems to play in fatigue.An in‐depth understanding of fatigue may help to inform a future patient‐centred intervention in ESKD.

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“…A previous study in which a perfect score was represented by 20 points showed that patients with higher scores had higher fatigue levels [11]. In a study in which the normal fatigue score level was not used, Koyama et al reported that the mean ± SD was 5.2 ± 4.1 in 171 healthy volunteers (age: 45.4 ± 14.0 years; male: 29.8%) [6].…”

Section: Evaluation Of Fatigue Levelsmentioning

confidence: 99%

“…Comprehensive metabolomic analyses of plasma from chronic fatigue syndrome have demonstrated that citrate was preferentially decreased, which suggested deficiencies in adenosine triphosphate production secondary to dysregulation of the flow from pyruvate to citrate via acetyl CoA and that dysfunctional energy metabolism through the citric acid cycle is a fatigue phenotype [23]. We previously reported that fatigue can be an important predictor for cardiovascular events in hemodialysis patients independent of their nutritional or inflammatory status [6]. It is important that patients are given hemodialysis treatment in consideration of the fatigue accumulated in daily life.…”

Section: St A(+)d 1st A(-)d After 2 Weeks Of A(+)d 7th A(-)d After 2mentioning

confidence: 99%

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The Effects of Acetate-Free Citrate-Containing Dialysate on Calcium Metabolism and Fatigue in Patients on Maintenance Hemodialysis

Yamada¹,

Inaba²,

Shoji³

et al. 2017

AJCEM

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Abstract:Although the significance of acetate-free citrate with 3.0 mEq/L Ca-containing-dialysate (A(−)D) has been reported, its effective Ca level and the overtreatment needed to correct metabolic acidosis on the basis of serum whole parathyroid hormone (wPTH) and arterial pH have not been evaluated in detail. Furthermore, recent reports have suggested the beneficial effect of citrate on fatigue, which is a significant risk for cardiovascular disease. Thirty-two hemodialysis patients receiving acetate with 2.75 mEq/L Ca-containing dialysate (A(+)D) participated in the present A(+)D to A(-)D one-arm switch study over 4 weeks. Predialysis wPTH increased significantly from 85.1 ± 59.0 pg/mL during hemodialysis A(+)D to 106.8 ± 78.8 pg/mL (p = 0.0015) after 2 weeks of A(-)D treatment. Predialysis arterial pH and bicarbonate levels significantly increased from 7.335 ± 0.037 to 7.370 ± 0.035 (p < 0.0001) and from 19.6 ± 2.1 mEq/L to 21.3 ± 1.7 mEq/L (p = 0.0001), respectively, whereas post-dialysis arterial pH and bicarbonate levels significantly increased from 7.447 ± 0.022 to 7.473 ± 0.027 (p < 0.0001) and from 25.2 ± 1.0 mEq/L to 28.1 ± 1.0 mEq/L (p < 0.0001). When all patients were divided into two equal-sized groups by fatigue score, the improvement in the fatigue score was significantly greater in the high group (∆1.8 ± 3.7) than in the low group (∆-0.8 ± 2.3) (p = 0.0252). This study demonstrated that the effective Ca level might be significantly lower in A(−)D than in A(+)D and metabolic acidosis was improved more strongly in A(-)D relative to that in A(+)D because of the higher bicarbonate concentration in A(-)D. Furthermore, A(-)D had a beneficial effect on intradialytic hemodynamics and fatigue sensation.

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Fatigue Is a Predictor for Cardiovascular Outcomes in Patients Undergoing Hemodialysis

Cited by 101 publications

References 42 publications

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

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

‘It's when you're not doing too much you feel tired’: A qualitative exploration of fatigue in end‐stage kidney disease

The Effects of Acetate-Free Citrate-Containing Dialysate on Calcium Metabolism and Fatigue in Patients on Maintenance Hemodialysis

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