Prevalence and associated variables of post‐dialysis fatigue: Results of a prospective multicentre study

Bossola, Maurizio; Marzetti, Emanuele; Stasio, Enrico Di; Monteburini, Tania; Cenerelli, Stefano; Mazzoli, Katia; Parodi, E; Sirolli, Vittorio; Santarelli, Stefano; Ippoliti, Fabio; Nebiolo, Pier Eugenio; Bonomini, Mario; Melatti, Roberta; Vulpio, Carlo

doi:10.1111/nep.13059

Cited by 28 publications

(44 citation statements)

References 40 publications

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“…Little is known about the determinants of recovery time [5][6][7]. Recently, we have demonstrated that recovery time is significantly associated with post-dialysis fatigue and that the severity of post-dialysis fatigue was negatively and weakly associated with the ultrafiltration rate (UFR) [8]. The association between a longer recovery time and a higher UFR has been shown by some authors but not by others [4,9].…”

Section: Introductionmentioning

confidence: 82%

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate

Bossola¹,

Stasio

Monteburini³

et al. 2018

Blood Purif

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Introduction: The present study aimed to determine the variables that are associated with a longer dialysis recovery time (DRT) and to define the relationship that exists between DRT and the ultrafiltration rate (UFR) in prevalent chronic hemodialysis (CHD) patients. Methods: We studied 210 prevalent CHD of 5 hemodialysis units in Central Italy. Patients were invited to answer to the question: “How long does it take you to recover from a dialysis session?” Answers to this question were subsequently converted into minutes. Demographic, clinical and laboratory parameters were recorded for each patient as well as the UFR (mL/kg/h), the dialysate sodium concentration and temperature. Results: Median DRT was 180 min (60–420). Ninety five (45%) patients had a DRT ≥ the median value. Mean UFR was 9.2 ± 3.0 mL/kg/h. Patients with a lower DRT had a less prevalent disability in the instrumental activities daily living, had a higher UFR, and a lower dialysate temperature, as compared with subjects with higher DRT. According to the logistic regression model, UFR was associated with a DRT below the median (i.e., 180) in the unadjusted model (OR 1.12; 95% CI 1.02–1.23; p = 0.019), after adjusting for age and sex (OR 1.11; 95% CI 1.01–1.22; p = 0.025), and in the fully adjusted model (OR 1.11; 95% CI 1.04–1.22; p = 0.040). UFR increase was associated with increasing probability of DRT below the median (p for trend = 0.035). The highest tertile of DRT was associated with UFR below the mean value (i.e., 9.2 mL/kg/h) in multinomial logistic regression having the lowest DRT tertile as reference. DRT was significantly lower in patients with UFR > 13 mL/kg/h than in patients with UFR 10–13 or < 10 mL/kg/h. Conclusion: DRT is inversely associated with UFR in CHD patients. Whether a high UFR should be recommended to reduce the DRT needs to be elucidated through an adequate prospective randomized study.

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Section: Introductionmentioning

confidence: 82%

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate

Bossola¹,

Stasio

Monteburini³

et al. 2018

Blood Purif

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“…At the time of inclusion in the study, patients underwent assessment of functional ability by the Katz ADL questionnaire and the Lawton and Brody IADL scale . Patients were subsequently categorized in ADL‐disabled (ADL = 0–5) or ADL‐competent (ADL = 6).…”

Section: Methodsmentioning

confidence: 99%

“…Recently, we have demonstrated that PDF is highly prevalent among patients on chronic hemodialysis, and is strongly associated with time of recovery after hemodialysis (TIRD), older age, and lower functional ability . We also showed that the severity of PDF is independently associated with ADL (activity daily living) .…”

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confidence: 87%

Prevalence and Severity of Postdialysis Fatigue Are Higher in Patients on Chronic Hemodialysis With Functional Disability

et al. 2018

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The aim of the present study was to determine the intensity, duration, frequency and prevalence of postdialysis fatigue (PDF) in patients on chronic hemodialysis (PCD) with and without functional disability. Patients underwent assessment of functional ability by the Katz ADL (activity daily living) questionnaire and the Lawton and Brody scale for the instrumental activity daily living (IADL) fatigue using the SF-36 Vitality Subscale, comorbidity through the Charlson comorbidity score index (CDI), and time of recovery after hemodialysis (TIRD). We studied 271 PCD. ADL and IADL disabilities were present in 75 (27.6%) and 168 (62%) patients, respectively. Patients with ADL disability were significantly older and showed higher CDI scores, and lower levels of serum albumin and Kt/V. Prevalence of PDF was significantly higher in patients with ADL disability as well as its severity, intensity, duration and frequency. Patients with IADL disability were significantly older, had a higher CCI score, had lower levels of serum albumin and Kt/V, and had a higher severity, intensity, duration and frequency of PDF. At multivariate regression analysis, ADL disability was positively associated with age, prevalence and severity of PDF, and dialysate temperature and inversely associated with serum albumin levels. IADL disability was instead positively associated with age and dialysate temperature and inversely associated with serum albumin levels. In conclusion, prevalence and severity of PDF are significantly higher in PCD with ADL disability than in those without it. This knowledge may have important implications for the development of interventions to reduce PDF in PCD.

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“…The causes and the pathogenesis of PDF are essentially unknown and this is essentially due to the lack of adequate longitudinal studies. Furthermore, a few studies that have evaluated the demographic, clinical and laboratory variables associated with PDF have been conducted (Sklar et al 1996; Gordon et al 2011; Dubin et al 2013; Bossola et al 2018a). As a possible cause of PDF, it has been suggested that the osmolarity decrease occurring during dialysis may lead to brain swelling and associated headache, nausea, muscle cramps and fatigue (Sklar et al 1996, 1998).…”

Section: Literature Reviewmentioning

confidence: 99%

“…Indeed, Dreisbach et al (1998) have shown that the intradialytic elevation of tumour necrosis factor‐α was significantly greater in patients with PDF than in those without. Interestingly, PDF has been was found to be significantly associated with symptoms of depression (Sklar et al 1996), disability (Bossola et al 2018a) and sedentary behaviour (Gordon et al 2011).…”

Section: Literature Reviewmentioning

confidence: 99%

Intensity, Duration, and Frequency of Post‐Dialysis Fatigue in Patients on Chronic Haemodialysis

Bossola

Stasio

Monteburini³

et al. 2020

Journal of Renal Care

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Bossola M., Di Stasio E., Monteburini T., et al. (2020). Intensity, duration, and frequency of post-dialysis fatigue in patients on chronic haemodialysis. Journal of Renal Care 46(2), 115-123. S U M M A R YBackground: Although frequent and debilitating, little is known about the characteristics of post-dialysis fatigue (PDF). Objective: To characterise the intensity, duration and frequency of PDF and the associated variables in patients on chronic haemodialyses. Design: Prospective, observational and multicenter study. Patients: We studied 271 patients. Measurements: Patients were considered to be suffering from PDF if they spontaneously offered this complaint when asked the open-ended question: "Do you feel fatigued after dialysis? Then, each patient was invited to rate the intensity, duration and frequency of PDF from 1 to 5. Results: One hundred sixty-four patients (60.5%) had PDF. The median [95% confidence interval (CI)] scores of PDF intensity, duration and frequency were 3 (3-4), 3 (3-4) and 4 (4-4), respectively. The median (95% CI) of the sum of the scores (Sum Score) of PDF intensity, duration and frequency was 11 (10-12). Seventy four patients had a Sum Score ≥ 12. Using multiple regression analysis, PDF intensity was associated with dialytic age and ultrafiltration rate (UFR), PDF duration with dialytic age, while PDF fatigue frequency was associated with height. The Sum Score was associated with dialytic age and recovery time and negatively associated with daily activity, height and UFR (ml/kg/h). Conclusion: The intensity, duration and frequency of PDF are high in a large percentage of patients, suggesting that PDF is an intense event in terms of quantity and quality. Understanding the relationship between the variables associated with PDF and its intensity, duration and frequency may help better understand the underlying mechanisms of this burdensome condition. K E Y W O R D S Haemodialyses⦁ Fatigue ⦁ Post-dialysis ⦁ Recovery time ⦁ Ultrafiltration rate

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Prevalence and associated variables of post‐dialysis fatigue: Results of a prospective multicentre study

Abstract: Post-dialysis fatigue is frequent and associated with age and ADL. Dialytic variables seem unrelated to PDF.

Cited by 28 publications

References 40 publications

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate

Prevalence and Severity of Postdialysis Fatigue Are Higher in Patients on Chronic Hemodialysis With Functional Disability

Intensity, Duration, and Frequency of Post‐Dialysis Fatigue in Patients on Chronic Haemodialysis

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