“…According to this model, primary disease factors, such as anaemia, inflammation, and dialysis may trigger fatigue, yet, how patients react cognitively, emotionally, and behaviourally to the initial symptom of fatigue may worsen, maintain and perpetuate fatigue over time (Figure 1; Donovan et al, 2007;van Kessel & Moss-Morris, 2006). The importance of these factors in maintaining and perpetuating fatigue has been extensively documented in other conditions, including multiple sclerosis (MS), rheumatoid arthritis (RA), and cancer (Ali et al, 2017;Als en et al, 2010;Grayson et al, 2013;Jopson & Moss-Morris, 2003;van Kessel & Moss-Morris, 2006;Zalai et al, 2015). Excessive rest may in turn lead to deconditioning, poor sleep and physiological arousal related to anxious mood, and lead to the perpetuation of fatigue (van Kessel & Moss-Morris, 2006; Van der Werf et al, 2003;Vercoulen et al, 1998;Wessely et al, 1998).…”