Postdialysis fatigue

Abstract

To clarify the demographic and clinicolaboratory features of postdialysis fatigue (PDF), we enrolled 85 patients on maintenance hemodialysis in a cross-sectional study using validated questionnaires and chart review. Forty-three patients complained of fatigue after dialysis. On formal testing using the Kidney Disease Questionnaire, the PDF group had statistically greater severity of fatigue and somatic complaints than the group of patients without subjective fatigue (P = 0.03 and 0.04, respectively). On a scale measuring intensity of fatigue (1 = least to 5 = worst), the PDF group average was 3.4 +/- 1.2. PDF subjects reported that 80% +/- 25% of dialysis treatments were followed by fatigue symptoms. In 28 (65%) of patients, the symptoms started with the first dialysis treatment. They reported needing an average of 4.8 hours of rest or sleep to overcome the fatigue symptoms (range, 0 to 24 hours). There were no significant differences between patients with and without PDF in the following parameters: age; sex; type of renal disease; presence of diabetes mellitus, heart disease (congestive, ischemic), or chronic obstructive lung disease; blood pressure response to dialysis; type or adequacy of dialysis regimen; hematocrit; electrolytes; blood urea nitrogen; creatinine; cholesterol; albumin; parathyroid hormone; ejection fraction; and use of antihistamines, benzodiazepines, and narcotics. In the fatigue group, there was significantly greater use of antihypertensive medications known to have fatigue as a side effect (P = 0.007). Depression was more common in the fatigue group by Beck Depression score (11.6 +/- 8.0 v 7.8 +/- 6.3; P = 0.02). We conclude that (1) postdialysis fatigue is a common, often incapacitating symptom in patients on chronic extracorporeal dialysis; (2) no routinely measured parameter of clinical or dialytic function appears to predict postdialysis fatigue; and (3) depression is highly associated with postdialysis fatigue, but the cause-effect relationship is unclear.

Preliminary study of an exercise programme for reducing fatigue and improving sleep among long-term haemodialysis patients

“…(21) Due to the older age of our cohort, it is possible that the prevalence of insomnia in our study was incidental to age. Studies by McCann and Boore (3) and Sklar et al (22) have reported high levels of depression among long-term haemodialysis patients, with factors such as enduring life with renal failure, long hours of haemodialysis and its complications, uncertainty about the future and financial issues being noted as the main causes of depression in these patients. Although there may have been a similar association between age and depression in our patients, this relationship was not investigated in our study.…”

The Psychological Impact of Hemodialysis on Patients with Chronic Renal Failure

“…People with chronic renal disease, regardless of whether they are predialysis or receiving either HD or PD, are reported having high levels of fatigue and are often unable to engage in normal daily activities (Bonner et al, 2010). In addition, fatigue is positively correlated with depression (Chen et al, 2010;Sklar et al, 1996), and negatively correlated with QoL . In one study, researchers noted a significant relationship between the duration of treatment and the level of fatigue.…”

Opioid and Benzodiazepine Use in End-Stage Renal Disease

“…Fifteen articles met inclusion criteria (1,7,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) (Figure 1). Agreement beyond chance between the two authors for article inclusion was good (kappa ϭ 0.79).…”

“…Five were from the United States (1,13,17,24,25), one was from Canada (7), and one was from Belgium (19). The remaining three included cross-sections of patients from between 7 and 12 countries (Dialysis Outcomes and Practice Patterns Study [DOPPS] I and II) (20,21,23).…”