Fatigue Is Associated with Increased Risk of Mortality in Patients on Chronic Hemodialysis

Bossola, Maurizio; Stasio, Enrico Di; Antocicco, Manuela; Panico, Loredana; Pepe, Gilda; Tazza, Luigi

doi:10.1159/000430827

Cited by 57 publications

(45 citation statements)

References 31 publications

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“…For example, in heart failure patients, fatigue was associated with cardiovascular death or hospitalization for heart failure [21]. In hemodialysis patients, fatigue was associated with all-cause death [7,9,36], the composite of first cardiac hospitalization or cardiac death [8], and cardiovascular events [37]. It was previously unknown whether fatigue is associated with these outcomes or renal outcomes in CKD-ND patients.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with CKD-D, fatigue impairs health-related quality of life [6] and is associated with mortality [7][8][9]. Several complex clinical factors, some of which may be modifiable, correlate with fatigue in patients with CKD-D, including higher burden of medical comorbidities, sedentary lifestyle, obesity, hypoalbuminemia, and use of sleeping medications [4,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

et al. 2019

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Background: Fatigue, although common and associated with outcomes in dialysis-dependent chronic kidney disease (CKD), has not been studied in nondialysis chronic kidney disease (CKD-ND) patients. Methods: In this longitudinal cohort of 266 outpatients with CKD-ND stages 2–5, we measured self-reported fatigue on 3 scales-Quick Inventory of Depression Symptomatology-Self Report (QIDS-SR₁₆), Beck Depression Inventory-I (BDI-I), and short form 12 health survey (SF-12) questionnaires and evaluated the prespecified composite of progression to dialysis initiation, death, or hospitalization after 12 months. Logistic and linear regression assessed characteristics associated with fatigue. Survival analysis measured associations of fatigue with outcomes. Results: Mean age was 64.4 ± 12.0 years, and mean estimated glomerular filtration rate (eGFR) was 31.6 ± 16.7 mL/min/1.73 m². Fatigue was common, with 69.2% reporting fatigue on QIDS-SR₁₆ and 77.7% on BDI-I. Unemployment, comorbidities, use of antidepressant medications, and lower hemoglobin correlated with fatigue. There were 126 outcome events. Participants that reported any versus no fatigue on QIDS-SR₁₆ were more likely to reach the composite, hazard ratio (HR) 1.70 (95% CI 1.11–2.59), which persisted after adjusting for demographics, comorbidities, substance abuse, hemoglobin, albumin, eGFR, and calcium-phosphorus product, HR 1.63 (1.05–2.55). Fatigue severity by the SF-12 was also associated with outcomes independent of demographics, comorbidities, and substance abuse, HR per unit increase 1.18 (1.03–1.35). No association was observed with fatigue on the BDI-I. Conclusion: Fatigue affected about 2/3 of CKD-ND patients and associated with unemployment, comorbidities, antidepressant medication use, and anemia. Fatigue measured by the QIDS-SR₁₆ and SF-12 independently predicted outcomes in CKD patients. Eliciting the presence of fatigue may be a clinically significant prognostic assessment in CKD patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

et al. 2019

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“…The MFI-20 contains a total of 20 items, purporting to measure 5 factors; general fatigue (items 1, 5, 12, 16), mental fatigue (items 7, 11, 13, 19), physical fatigue (items 2,8,14,20), reduced motivation (items 4, 9, 15, 18) and reduced activity (items 3, 6, 10, 17). Each factor contains 4 items and is scored on a 5-point Likert type scale, where participants rate each item according to their agreement ("yes, that is true" to disagreement "no, that is not true").…”

Section: Fatigue Measurementioning

confidence: 99%

“…Fatigue is a burdensome and common symptom in patients with end-stage kidney failure (ESKF), which is associated with poor outcomes [1] , including survival [2] . Accordingly, there is growing recognition regarding the importance of understanding fatigue in ESKF [3][4][5] and developing evidence-based interventions to ameliorate symptoms.…”

Section: Introductionmentioning

confidence: 99%

Measuring Fatigue Using the Multidimensional Fatigue Inventory-20: A Questionable Factor Structure in Haemodialysis Patients

Chilcot

Guirguis

Friedli

et al. 2017

Nephron

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Background/Aims: Fatigue is recognised as a common and burdensome symptom among dialysis patients. A growing body of research is devoted to understanding fatigue in advanced kidney disease, yet its measurement is challenging within this context. Our aim was to evaluate the factor structure underlying the multidimensional fatigue inventory (MFI-20) and to examine its associations with clinical factors and mood. Methods: Data was evaluated for confirmatory factor analysis (CFA) from the screening phase of a multicentre randomised placebo-controlled trial of sertraline in haemodialysis (HD) patients. Four hundred seventy patients completed the MFI-20, which purports to measure 5 components of fatigue (general fatigue, mental fatigue, physical fatigue, reduced motivation and reduced activity). CFA models were evaluated in MPlus 7.3 using the robust maximum likelihood (MLR) estimation. Results: The evaluation of the original 5 factors revealed low internal reliability for the general factor and reduced activity, and high intercorrelations between all sum scores. CFA revealed poor model fit for the original 5-factor MFI-20 model (confirmatory fit index = 0.738; Tucker-Lewis index = 0.689; root mean squared error of approximation = 0.101). Alternative models, including 1, 3 and bi-factor models all demonstrated poor fit to the data. No reliable factor model was confirmed prohibiting the examination of factors associated with fatigue. Conclusions: We were not able to confirm the factor structure of the MFI-20 in a large sample of HD patients. Certain items may lack suitable face validity in this context.

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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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Fatigue Is Associated with Increased Risk of Mortality in Patients on Chronic Hemodialysis

Cited by 57 publications

References 31 publications

Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes

Measuring Fatigue Using the Multidimensional Fatigue Inventory-20: A Questionable Factor Structure in Haemodialysis Patients

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

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