Severe fatigue after kidney transplantation: a highly prevalent, disabling and multifactorial symptom

Abstract

SummaryFatigue is a common symptom of patients with chronic kidney disease, but seldom investigated after transplantation. We determined the prevalence, impact and related factors of severe fatigue in kidney transplant recipients (KTRs). Medical records and questionnaires were used to assess kidney function, donor characteristics, fatigue (Checklist Individual Strength), functional impairments (Sickness Impact Profile), work status, body mass index (BMI), pain, depressive symptoms, social support and sleeping problems in 180 participating KTRs. KTRs were compared with sex-and age-matched population-based controls. KTRs were significantly more often severely fatigued (39%) compared to matched controls (22%; P = 0.001). Severely fatigued KTRs had significantly more functional impairments than nonseverely fatigued recipients (effect size ≥ 0.7) P < 0.001, and less often a paid job (27% vs. 48%, P = 0.005). Univariate analysis showed that severely fatigued KTRs received more often a kidney from a deceased donor, had a higher BMI, more pain, discrepancy in social support, depressive symptoms and sleeping problems. In a multivariate analysis (n = 151) the latter two associations remained significant. Severe fatigue is a highly prevalent and disabling symptom in KTRs. Moreover, severe fatigue after kidney transplantation is more strongly related to behavioural and psychosocial factors than specific transplantation-related factors. Findings have implications for fatigue management.

Cardiovascular, muscular and perceptual contributions to physical fatigue in prevalent kidney transplant recipients

“…In turn, mental fatigue is significantly associated with such heightened perception of effort. The findings of the current study also confirm physical fatigue as a common and disabling symptom among KTRs, negatively impacting on QoL . Whilst novel to transplantation, these results resonate with recent findings emerged from other populations, whereby heightened perception limits exercise capacity in healthy trained individuals and diabetic patients , and mental fatigue impairs physical performance in healthy subjects through increased perception of effort rather than limiting musculoenergetic or cardiovascular function .…”

Fatigue in kidney transplant recipients

“…After undergoing transplantation, patients moved from the 18th percentile of the US population scores to the 50th percentile for vitality and 54th percentile for role‐emotional functioning. In the study of Goedendorp et al., the prevalence of severe fatigue was significantly higher in KTR (39%) than in controls (22%; P =.001). Chan et al .…”

“…It is interesting to note that such fatigue‐related variables (inflammation, depression, sleep disorders) in KTR are found also and commonly in dialysis patients. Finally, two studies have shown that fatigue in KTR is significantly associated with obesity . Noteworthy, living donor recipients transplanted less than or equal to 5 years reported significantly less fatigue than deceased donor recipients on all subscales of the MFI‐20 except for mental fatigue and reduced motivation at univariate analysis .…”

“…Chronic inflammation is common in KTR and similar for frequency and severity to inflammation of chronic kidney disease patients . Fatigue in KTR is significantly associated with symptoms of depression and/or sleep disorders . However, depressive symptoms could not completely explain the presence of severe fatigue.…”

“…Fatigue has deleterious effects in KTR (Table ). In fact, it determines a significant more severe functional impairment, either when globally considered (sickness impact profile: (950±707 in severely fatigued vs 242±274 in nonseverely fatigued KTR) or when analyzed at the level of the single domains such as sleep and rest 109±90 vs 27±39), homemaking (114±108 vs 31±46), mobility (63±105 vs 6±23), social interaction (192±216 vs 42±90), ambulation (84±111 vs 17±41), leisure activities (94±81 vs 23±40), alertness behavior (950±707 vs 62±125), work limitations (164±170 vs 62±125) . In addition, fatigue in KTR is significantly associated with a severe deterioration of quality of life …”