Fatigue in advanced kidney disease

Abstract

Fatigue is commonly experienced in patients with advanced kidney disease and associated with poor outcomes. The prevalence of fatigue ranges from 42% to as high as 89% according to treatment modality and the measurement instruments used. This paper reviews studies examining sociodemographic, biological, and psychological factors associated with fatigue in advanced kidney disease. The association between fatigue and psychological factors, such as depression and anxiety, behavioral factors, such as sleep and nutrition, and cytokines, such as IL-6 and CRP corroborates the view of fatigue as a multidimensional and multifactorial problem. Although depression and fatigue are related, the relationship is typically moderate in size, thus fatigue should not simply be seen as a symptom of distress. Accordingly, it is important for treatment plans to address the complex etiology of fatigue through pharmacological and nonpharmacological interventions. To date, results of nonpharmacological interventions are promising, with physical exercise and cognitive-behavioral therapy showing beneficial results. Work conducted in other patient populations highlights the importance of cognitions and behaviors in the prediction and maintenance of fatigue. Such work could be applied to advanced kidney disease allowing a model of fatigue to be developed from which to base suitable interventions in this setting.

C reactive protein and depressive symptoms in hemodialysis patients: A questionable association

“…Whereas the BDI-II having 21 questions, with different scores relating to severity of replies, with 4 questions relating to difficulty with sleeping, lack of energy, fatigue and poor appetite. As such there may be a greater overlap between symptoms associated with chronic kidney disease [27] and the PHQ-9 compared to the BDI-II.…”

“…Depression scores were similar in those with normal and high CRP (BDI-II (9(5-17) vs 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)) or PHQ (4(2-9) vs 6(2-10)). In adjusted multivariable regression BDI-II scores were associated with previous history of depression (β 10.8, p<0.001), serum albumin (β 0.41, p<0.001), anuria (β 2.4, p<0.037), diabetes (β 2.7, p=0.033) and age (β -0.10, p=0.009).…”

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

“…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). …”

Aging and low-grade inflammation reduce renal function in middle-aged and older adults in Japan and the USA

“…Poor renal function has also been linked with fatigue, anxiety, and impaired cognitive performance and thus is of relevance to behavioral medicine research with the elderly (Artom et al 2014;Dalui et al 2014;Silverwood et al 2014).…”