Anorexia, fatigue, and plasma interleukin-6 levels in chronic hemodialysis patients

Abstract

This study aimed at evaluating the possible relationship between anorexia and fatigue in hemodialysis (HD) patients and at measuring the plasma levels of interleukin-6 (IL-6) and C-reactive protein (CRP) in HD patients with or without anorexia and/or fatigue. The first question of the Hemodialysis Study Appetite questionnaire was used to assess the appetite of the HD patients and the vitality scale of the SF-36 to assess fatigue. The Charlson Comorbidity Index was assessed in each patient. Seventy-six HD patients were studied. Forty-four were males and 32 females. Thirty-two were classified as not-anorexic and not-fatigued, 12 as not-anorexic but fatigued, 6 as anorexic and not-fatigued, and 26 as anorexic and fatigued. Plasma IL-6 levels (pg/mL) were significantly higher in anorexic and fatigued patients (10.9 ± 11.9) than in not-anorexic and not-fatigued (1.6 ± 0.6) ( p < 0.001) and in anorexic but not-fatigued patients (1.8 ± 1.7) (p < 0.01). With respect to not-anorexic but fatigued patients (3.1 ± 1.5), the difference was not statistically significant (p = 0.058). The plasma CRP levels (mg/dL) also were significantly higher in anorexic and fatigued patients (9.2 ± 6.3) than in not-anorexic and not-fatigued patients (4.1 ± 4.5), in anorexic but not-fatigued patients (2.5 ± 1.6), and in not-anorexic but fatigued patients (4.1 ± 4.4) ( p = 0.001). The presence of both anorexia and fatigue in chronic HD patients is associated with significantly higher levels of plasma IL-6 and CRP and a higher frequency of comorbidities.

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

“…In this situation, patients could experience stress and emotion fluctuation, all of which resulted in tiredness, exhaustion, and an increase in patients' fatigue level. 50 In our present study, less than one-third of MHD patients exercised more than one hour per day. A physical exercise program was found to be one of the positive factors in managing fatigue.…”

Impact of Fatigue on Outcomes in the Hemodialysis (HEMO) Study

“…The principal obstacles to improving our understanding and treatment of fatigue in ESRD patients are the relative paucity of data on its correlates and clinical implications, conflicting findings and a dearth of longitudinal data on the potentially modifiable correlates. Multiple physiologic, psychological, sociodemographic and treatment-related factors are likely associated with fatigue, but their complex and reciprocal interactions with fatigue are poorly understood [1,2,11,12]. If fatigue influences health- related quality of life (HRQOL) and/or survival, there would be a strong rationale for identification of fatigue and its correlates early in HD patients.…”

Appetite Is Associated with the Time of Recovery after the Dialytic Session in Patients on Chronic Hemodialysis

“…Recently, we demonstrated that appetite is independently associated with many other symptoms such as symptoms of depression [11], fatigue [10] and gastrointestinal symptoms [9]. Consistently, a longer time of recovery also has been shown to be associated with fatigue [13], gastrointestinal symptoms such as nausea and vomiting [12], and symptoms of depression [12].…”

“…It has been proposed that uremic toxins such as middle molecules, inflammation, altered pattern of amino acids, hormones and peptides may be involved [4,5,6,7,8]. Recently, we have shown that poor appetite is independently associated with gastrointestinal symptoms [9], fatigue [10] and symptoms of depression [11]. Similarly to anorexia in cancer, it seems that anorexia in HD patients is not an isolated symptom, but part of a complex of symptoms.…”