Higher Postdialysis Lactic Acid Is Associated with Postdialysis Fatigue in Maintenance of Hemodialysis Patients

Abstract

Background: Postdialysis fatigue (PDF) is not an unusual symptom among hemodialysis (HD) patients; however, its causes remain unclear. The aim of this study was to analyze the factors responsible for PDF in maintenance HD patients. Methods: This was a single-center cross-sectional study conducted between March 2018 and March 2019 at the Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University. One hundred and fifteen HD patients were enrolled. Clinical data on demographics, comorbidities, and the primary cause of end-stage renal disease were obtained by questionnaires. Laboratory data were collected pre-and post-HD. Participants were divided into 3 groups according to PDF degree. Results: The prevalence of PDF in participants was 60% (n = 69); 26.09% had mild PDF; and 33.91% had severe PDF. In the severe PDF group, the prevalence of intradialytic hypotension (IDH) was 38.46%, significantly higher than in the no PDF group (no-PDF; 8.70%) and mild-PDF (16.67%; p = 0.01 for both) groups. In the severe-PDF group, Charlson comorbidity index score and ultrafiltration rate were significantly higher than those in the no-PDF group (p = 0.040, p = 0.020, respectively). In the severe-PDF group, postdialysis lactic acid (Lac) level was significantly higher than that in the no-PDF or mild-PDF groups (p = 0.013 for both). And in the severe-PDF group, postdialysis sodium (Na) was significantly lower than that in the no-PDF or mild-PDF groups (p = 0.026 for both). It was shown by unconditional logistic regression analysis that IDH occurrence (OR 3.821, 95% CI 1.330-10.975), ultrafiltration rates (OR 1.142, 95% CI 1.018-1.281), lower postdialysis Na level (OR 0.724, 95% CI 0.556-0.942), and higher postdialysis Lac level (OR 2.465, 95% CI 1.126-5.397) were associated with PDF (p = 0.013, p = 0.024, p = 0.016, and p = 0.024, respectively). Conclusions: The prevalence of PDF was high among our study participants. PDF incidence was correlated with the IDH occurrence and higher postdialysis Lac and lower postdialysis Na levels. The level of Lac was a significant influencing factor for the fatigue of patients. More attention should thus be paid to PDF.

Post‐dialysis fatigue and peri‐dialytic serum lactate levels in patients on chronic hemodialysis

“…The results of the present study are partly in disagreement with the study by Zu et al who reported that the median post-dialysis SL levels (mmol/L) were 1.6, 1.3, 1.5 in patients with no PDF, moderate PDF, and severe PDF, respectively (p = 0.013) [4]. However, if we consider the reference limits for SL reported as >2 mmoL/L, the present study demonstrates that the frequency of post-dialysis SL >2 mmoL/L does not differ significantly between patients with and without PDF similarly to the study of Zu et al Interestingly, in the study of Zu et al, studied patients were much younger than patients included in our study.…”

Prevalence of post-dialysis fatigue: a systematic review and meta-analysis

“…Finally, we included 12 studies, comprising 2152 patients, in the meta-analysis (figure 1). Based on the AHRQ and NOS assessments, 11 studies8 18–27 were of moderate quality, while only 1 article28 was classified as high quality among the eligible studies.…”

“…The characteristics of the 12 eligible studies,8 18–28 published between 1996 and 2021, originating from China as well as America and Europe, are presented in online supplemental table 1. Among these studies, eight were conducted in China,18–24 28 while four took place in America and Europe 8 25–27. A single study was a prospective cohort study,28 while the remaining studies were cross-sectional8 18–27 (n=11).…”

“…Among these studies, eight were conducted in China,18–24 28 while four took place in America and Europe 8 25–27. A single study was a prospective cohort study,28 while the remaining studies were cross-sectional8 18–27 (n=11). The sample sizes varied from 45 to 626, encompassing a total of 2152 patients, out of which 1215 had experienced PDF.…”

Factors associated with subgroups of fatigue in maintenance hemodialysis patients: a cross-sectional study

“…Hence, the fatigue of MHD patients is believed to be distinct from that of other non-hemodialysis patients and needs further exploration [ 13 ]. Previous studies have mainly focused on post-dialysis fatigue (PDF), which is the most common type of fatigue in MHD patients, and have found some new factors related to it, such as higher post-dialysis lactic acid, the number of sleep hours before HD, and peridialytic serum cytokines [ 14–16 ]. Besides PDF, fatigue symptoms can also occur before dialysis or continuously exist during a dialysis session and can be lessened or worsened by HD treatment.…”