Fatigue is associated with high prevalence and severity of physical and emotional symptoms in patients on chronic hemodialysis

Symptom Burden in Patients on Maintenance Hemodialysis: Prevalence and Severity 17 Years Apart

Objectives: The aim of this study is to compare data from two cohorts separated by a 17-year interval. We assessed the prevalence and severity of symptoms with the "dialysis symptom index" in these two groups, recruited in 2007 and 2024, to determine how advancements in dialysis therapy have influenced the symptom burden's prevalence and severity. Methods: End-stage renal diseases patients receiving maintenance hemodialysis three times a week in the hemodialysis unit of the university hospital were recruited between February and March 2007. In May 2024, in the same unit, another population sample was recruited and studied, as in 2007. The Dialysis Symptom Index (DSI) was administered to each patient, during the dialysis treatment. The DSI is made up of 30 questions, each of which addresses a specific physical or emotional symptom. The total symptom burden score, representing the total number of symptoms reported as being present, and the total symptom severity score, which represents the sum of individual severity scores, were generated for each patient. Results: We studied 71 patients in 2007 and 61 patients in 2024. The demographic, clinical and laboratory characteristics of the two study populations did not differ significantly. The total symptom burden score did not differ significantly between 2007 and 2024. The prevalence of most symptoms was similar in the two groups. The prevalence of constipation, decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. The total symptom severity was similar in the two periods. The severity of most symptoms was similar in the two groups. The severity of decreased interest in sex and difficulty in becoming sexually aroused was higher in 2024 than in 2007. Conclusions: The present study shows that, 17 years apart, the prevalence and severity of the symptom burden in patients on maintenance hemodialysis did not change significantly. These results suggest that studies investigating the causes and the pathogenesis of symptoms of patients on maintenance hemodialysis are urgently needed in the next future, as well as studies on therapeutic strategies.

Effects of physical and psychological symptoms on cancer-related fatigue among esophageal cancer patients

BACKGROUND

Cancer-related fatigue (CRF) is considered one of the most prevalent and distressing symptoms among cancer patients and may vary among patients with different cancer types. However, few studies have explored the influence of physical and psychological symptoms on CRF among esophageal cancer (EC) patients without esophagectomy. Therefore, this study aimed to examine the effects of physical and psychological symptoms on CRF among EC patients without esophagectomy.

METHODS

In the present study, a cross-sectional study was conducted from February 2021 to March 2022 in Liaoning Province, China. Among the 112 included participants, 97 completed our investigation. The questionnaires used consisted of the Brief Fatigue Inventory (BFI), the MD Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and demographic and clinical information. Multivariate linear regression was conducted to test the relationships between physical and psychological symptoms and CRF.

RESULTS

Of the 97 EC patients, 60.8% reported CRF (BFI ≥ 4). The mean age of the participants was 64.92 years (SD = 8.67). According to the regression model, all the variables explained 74.5% of the variance in CRF. Regression analysis indicated that physical symptoms, including constipation, diarrhoea, and difficulty swallowing, contributed to CRF. On the other hand, depressive symptoms increased the level of CRF among EC patients without esophagectomy.

CONCLUSIONS

Given the high prevalence of CRF among EC patients without esophagectomy, it is urgent to emphasize the importance of fatigue management interventions based on physical and psychological symptoms to alleviate CRF in EC patients.

Dialysis vintage is associated with a high prevalence and severity of unpleasant symptoms in patients on hemodialysis

Background: The burden of physical and emotional symptoms caused by somatic illness is present in most dialysis patients. However, it's unclear how symptom burden varies among patients with different dialysis vintages. We sought to examine differences in the prevalence and severity of unpleasant symptoms in hemodialysis patients with diverse dialysis vintage cohorts.Methods: This cross-sectional study included patients on maintenance hemodialysis at the Second Hospital of Anhui Medical University. We used the Dialysis Symptom Index (DSI) to determine the associated unpleasant symptoms, which is a validated survey to assess symptom burden/severity (higher scores indicate more severe symptoms), over June 2022 - September 2022.Results: We studied 146 patients: 35 (24%) had a dialysis vintage of ≤12 months (group 1) and 111 (76%) had a dialysis vintage of >12 months (group 2). Concerning Group 1 patients, the prevalence and severity of unpleasant symptoms were significantly higher in Group 2, the most common individual symptoms included feeling tired or lack of energy and trouble falling asleep (i.e., 75-85% of patients in each group), with dialysis vintage being an independent influencing factor (adjusted OR, 0.19; 95% CI, 0.16 to 0.23). Lower hemoglobin levels, iron stores, and dialysis adequacy levels are correlated with longer dialysis vintage.Conclusion: We observed a high prevalence of unpleasant symptoms and symptom clusters in a diverse dialysis vintages hemodialysis cohort. Further studies are needed to accurately and routinely define the symptom burden of chronic patients with chronic kidney disease (CKD).

Exploring the Needs of Patients Undergoing Hemodialysis: A Qualitative Study

BACKGROUND

 Many studies have focused on patients' experiences living with hemodialysis therapy; however, there is little research exploring their needs. Therefore, the purpose of this study was to explore hemodialysis patients' needs in Saudi Arabia.

METHODS

A qualitative research design with semi-structured interviews was used. Data were collected from Aghrass Medical Center, Jeddah, Saudi Arabia. Data were analyzed using thematic analysis.

RESULTS

A total of 16 hemodialysis patients underwent in-depth interviews. The mean age of the participants was 49 ± 14.93 years of age. More than half of the participants were male (56.25%), and most of them were married (75%). Regarding the clinical characteristics, all patients had three sessions in a week, and the average duration was four hours per session. The mean number of years on dialysis therapy was 3.80 ± 2.8. Using thematic analysis, four themes emerged. These were the impact of fatigue and need for fatigue self-management, need for family and social support, psychological and emotional support from healthcare professionals, and changes in the patients' role performance and their need for adaptation.  Conclusions: This study highlights the aspects of needs among hemodialysis patients from their own perspective. Four themes of needs emerged from this study. Consequently, healthcare professionals should assess patients' needs frequently to ensure high-quality care.

From Exhaustion to Empowerment: Investigating Fatigue and Its Associations in Patients With End-Stage Renal Disease on Maintenance Hemodialysis

Introduction Patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis (MHD) frequently experience fatigue. This cross-sectional study examined the severity of fatigue and the demographic and clinical characteristics that may contribute to fatigue in ESRD patients on MHD. Methods The study included 250 ESRD patients on MHD. Age, gender, marital status, occupation, level of education, and information regarding dialysis and laboratory parameters were gathered. The Fatigue Assessment Scale (FAS) was used to quantify fatigue. The FAS consisted of 10 questions. Fatigue severity was categorized into three groups based on the total FAS score. Results The mean fatigue score using FAS in our study was 22.1 ± 4.1 (47.2%), indicating a moderate level of fatigue among the participants. Approximately 47.2% of the patients reported moderate fatigue, while severe fatigue was not observed in our study. Employment status showed a significant association with fatigue, with a higher prevalence among unemployed individuals 56 (47.5%) and those engaged in housework 40 (33.9%). The duration of hemodialysis was also significantly associated with fatigue in our study (p < 0.001), with patients undergoing treatment for more than 4 years experiencing a higher prevalence of 81 (68.7%). Among the demographic and clinical parameters analyzed, age, gender, residence, education, socioeconomic status, and comorbid conditions did not show a significant association with fatigue. However, phosphorus levels demonstrated a significant association (p = 0.014), with higher levels being associated with a decreased chance of experiencing fatigue. Conclusion These findings suggest that employment status and the duration of hemodialysis are potential factors influencing fatigue in ESRD patients on MHD. Furthermore, it is possible that phosphorus levels affect how tiredness manifests. Understanding these factors can contribute to improved management and timely interventions to address fatigue in this patient population. It is important to conduct more studies to understand the causes of fatigue in ESRD patients receiving MHD, as well as possible treatments.

Prevalence of post-dialysis fatigue: a systematic review and meta-analysis

OBJECTIVES

The purpose of this study was to synthesise data on the prevalence of post-dialysis fatigue (PDF) among haemodialysis (HD) patients.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

China National Knowledge Infrastructure, Wanfang, Chinese Biological Medical Database, PubMed, EMBASE and Web of Science were searched from their inception to 1 April 2022.

ELIGIBILITY CRITERIA

We selected patients who must receive HD treatment for at least 3 months. Cross-sectional or cohort studies published in Chinese or English were eligible for inclusion. The main search terms used in the abstract were: "renal dialysis", "hemodialysis" and "post-dialysis", in combination with the word "fatigue".

DATA EXTRACTION AND SYNTHESIS

Two investigators independently performed data extraction and quality assessment. Data were pooled to estimate the overall prevalence of PDF among HD patients using the random-effects model. Cochran's Q and I² statistics were adopted to evaluate heterogeneity.

RESULT

A total of 12 studies were included, with 2152 HD patients, of which 1215 were defined as having PDF. The overall prevalence of PDF in HD patients was 61.0% (95% CI: 53.6% to 68.3%, p<0.001, I²=90.0%). Subgroup analysis failed to explain the source of heterogeneity, but univariable meta-regression showed that a mean age of ≥50 years might be the source of heterogeneity. Egger's test revealed no publication bias among the studies (p=0.144).

CONCLUSIONS

PDF is highly prevalent among HD patients.

Prevalence and predisposing factors for fatigue in patients with chronic renal disease undergoing hemodialysis: a cross-sectional study

BACKGROUND

Patients with chronic renal disease and undergoing hemodialysis are at a high risk for developing several complications. Fatigue is a common, troubling symptom that affects such patients and can contribute to unfavorable outcomes and high mortality.

OBJECTIVE

This cross-sectional study aimed to evaluate the prevalence of fatigue in Brazilian patients with chronic kidney disease undergoing hemodialysis and determine the predisposing factors for fatigue.

DESIGN AND SETTING

An observational, cross-sectional, descriptive study was conducted in two renal replacement therapy centers in the Greater ABC region of São Paulo.

METHODS

This study included 95 patients undergoing dialysis who were consecutively treated at two Brazilian renal replacement therapy centers between September 2019 and February 2020. The Chalder questionnaire was used to evaluate fatigue. Clinical, sociodemographic, and laboratory data of the patients were recorded, and the Short Form 36 Health Survey, Pittsburgh Sleep Quality Index, and Beck Depression Inventory were administered.

RESULTS

The prevalence of fatigue in patients undergoing hemodialysis was 51.6%. Fatigue was independently associated with lower quality of life in terms of physical and general health. Patients with fatigue had a higher incidence of depression (65.9% vs. 34.1%, P = 0.001) and worse sleep quality (59.1% vs. 49.9%; P = 0.027) than those without fatigue.

CONCLUSION

Prevalence of fatigue is high in patients undergoing hemodialysis and is directly related to physical and general health.

The impact of nurse-led nonpharmacological multidisciplinary holistic nursing care on fatigue patients receiving hemodialysis: a randomized, parallel-group, controlled trial

BACKGROUND

Fatigue is a symptom characterized by an elevated prevalence in patients undergoing hemodialysis, which may cause extreme mental and muscular debilitation, significantly influencing social interaction, life quality and well-being. However, the significance of fatigue to patients undergoing hemodialysis has not been recognized yet, and prevention and management of fatigue in this population have not been thoroughly investigated. Additionally, previous studies mainly focused on muscular fatigue, while mental fatigue has been seldom discussed. This study aims to investigate the interaction between nurses and multidisciplinary of nonpharmacological integrated care interventions (NICIs) and assess the impact of fatigue on patients undergoing hemodialysis.

METHODS

The integrative nonpharmacological care interventions in this study included walking, motivational interviewing (MI) and health education regarding behavioral self-management. A single-center randomized controlled trial was conducted in the dialysis center of the nephrological department in a tertiary affiliated hospital of medical university from January to June 2019. A total of 118 patients were selected and randomly divided into the intervention group (IG) and the control group (CG). Four patients dropped out during the study, and 114 patients were enrolled for the eventual analysis. The 60 patients in the IG received routine nursing combined with integrated care interventions, while the 54 patients in the CG received routine nursing only. This study lasted for six months.

RESULTS

The experimental group exhibited significant reductions of overall fatigue (2.26 vs. 0.48), mental fatigue (1.41 vs. 0.54), muscular fatigue (2.13 vs. 0.75), and some biochemical indicators (e.g., serum urea) (P<0.05), compared with the CG.

CONCLUSIONS

Nurses and multidisciplinary teams have been demonstrated to play a key role and interplay function in chronic disease management. Hence, the nurse-led multidisciplinary NICIs significantly alleviated total fatigue (muscular fatigue and mental fatigue) and improved other parameters.

TRIAL REGISTRATION

ChiCTR-IOR-16008621 (March 18, 2016).

The Effect of Nonpharmacological Integrated Care Protocols on Patients with Fatigue Undergoing Hemodialysis: A Randomized Controlled Trial

This study was designed to investigate the effects of nonpharmacological integrated care protocols on fatigue in patients with hemodialysis. This parallel randomized controlled trial was conducted on patients undergoing hemodialysis from May to October 2020 at the Dialysis Center of the Fifth Affiliated Hospital of Zunyi Medical University. The patients were randomized into an intervention group (accepting nonpharmacological integrated care protocols and standard care) or a control group (accepting standard care only) using a computer-generated random number. The nonpharmacological holistic care intervention used in this study involved a well-rounded multidisciplinary team that worked together to improve dietary compliance, medication adherence, and self-management to improve patients' care and promote self-management. From the 120 evaluated patients, 116 cases were eligible and analyzed. The results showed that patients from the intervention group had obviously reduced overall fatigue, mental fatigue, and muscular fatigue relative to the control group. The nonpharmacological integrated care protocols were interactive and promotive to each other. Meanwhile, the role and function of nurses in the management of chronic disease were demonstrated to be crucial.

Ethical Challenges When Caring for African American Older Adults Requesting to Withdraw From Dialysis

The number of African American adults 65 years and older with end-stage kidney disease receiving maintenance hemodialysis is increasing. The high symptom burden (ie, pain, fatigue, depression) can make it challenging for many to continue dialysis, which can lead to request to withdraw from dialysis. This can present ethical challenges when someone has diminished decision-making capacity and no advance directives or family to assist with this complex decision. This article will provide a brief overview of ethical issues to consider when responding to an older adult's request to withdraw from a life-sustaining treatment such as dialysis. Suggestions for research to address the gaps in knowledge will be presented.

Evaluation of the Effect of Lavender Aroma on Fatigue Among Hemodialysis Patients

Fatigue is a complication of hemodialysis (HD). We examined the effect of aromatherapy on fatigue in 62 HD patients. Data were collected using a questionnaire and the Piper Fatigue Scale. It was found that fatigue decreased in the intervention group (P < .05). Lavender aromatherapy is useful in reducing fatigue.

The Prevalence and Severity of Chronic Pain in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Background:

Chronic pain is a common and distressing symptom reported by patients with chronic kidney disease (CKD). Clinical practice and research in this area do not appear to be advancing sufficiently to address the issue of chronic pain management in patients with CKD.

Objectives:

To determine the prevalence and severity of chronic pain in patients with CKD.

Design:

Systematic review and meta-analysis.

Setting:

Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity.

Patients:

Adults with glomerular filtration rate (GFR) category 3 to 5 CKD including dialysis patients and those managed conservatively without dialysis.

Measurements:

Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of pain, and severity of pain.

Methods:

Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library, last searched on February 3, 2020. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of overall chronic pain, musculoskeletal pain, bone/joint pain, muscle pain/soreness, and neuropathic pain and the I² statistic was computed to measure heterogeneity. Random effects models were used to account for variations in study design and sample populations and a double arcsine transformation was used in the model calculations to account for potential overweighting of studies reporting either very high or very low prevalence measurements. Pain severity scores were calibrated to a score out of 10, to compare across studies. Weighted mean severity scores and 95% confidence intervals were reported.

Results:

Sixty-eight studies representing 16 558 patients from 26 countries were included. The mean prevalence of chronic pain in hemodialysis patients was 60.5%, and the mean prevalence of moderate or severe pain was 43.6%. Although limited, pain prevalence data for peritoneal dialysis patients (35.9%), those managed conservatively without dialysis (59.8%), those following withdrawal of dialysis (39.2%), and patients with earlier GFR category of CKD (61.2%) suggest similarly high prevalence rates.

Limitations:

Studies lacked a consistent approach to defining the chronicity and nature of pain. There was also variability in the measures used to determine pain severity, limiting the ability to compare findings across populations. Furthermore, most studies reported mean severity scores for the entire cohort, rather than reporting the prevalence (numerator and denominator) for each of the pain severity categories (mild, moderate, and severe). Mean severity scores for a population do not allow for “responder analyses” nor allow for an understanding of clinically relevant pain.

Conclusions:

Chronic pain is common and often severe across diverse CKD populations providing a strong imperative to establish chronic pain management as a clinical and research priority. Future research needs to move toward a better understanding of the determinants of chronic pain and to evaluating the effectiveness of pain management strategies with particular attention to the patient outcomes such as overall symptom burden, physical function, and quality of life. The current variability in the outcome measures used to assess pain limits the ability to pool data or make comparisons among studies, which will hinder future evaluations of the efficacy and effectiveness of treatments. Recommendations for measuring and reporting pain in future CKD studies are provided.

Trial registration:

PROSPERO Registration number CRD42020166965

Avaliação de fadiga e fatores associados em pessoas submetidas à hemodiálise

Introdução: o sintoma de fadiga é considerado incapacitante e afeta a qualidade de vida das pessoas com doença renal crônica, em tratamento de hemodiálise. Objetivo: avaliar a prevalência, intensidade e severidade do sintoma de fadiga em pessoas com doença renal crônica em tratamento hemodialítico. Materiais e Método: Estudo quantitativo descritivo, do qual participaram 335 pessoas em tratamento hemodialítico. Para a coleta dos dados foram utilizadas as escalas Visual Analog Scale” de 100mm, escala de severidade de fadiga e um questionário sociodemográfico. Foram analisadas as variáveis dependentes das escalas de fadiga, com as independentes de caracterização sociodemográfica e clínica. Resultados: Identificaram-se 58% do sexo masculino, idade entre 20-59 anos em 52,2%, predomínio de cor branca em 68,2%, 68,6% com baixa escolaridade, aposentadoria como principal renda em 55,7%, renda entre R$ 800,01 e R$1760,00 em 42,4%, a prevalência de fadiga foi de 63,0%, fadiga severa em viúvos (35,2%) e mulheres (27,6%), sendo que a principal comorbidade foi a Hipertensão Arterial Sistêmica (40,9%). A intensidade de fadiga teve o valor médio de 42,3(DP=32,2) e a severidade de fadiga teve valor médio de 35,8(DP=17,8). Conclusões: evidenciou-se que o fator socioeconômico e as comorbidades influenciam no sintoma de fadiga em mulheres, viúvos e idosos. O uso de instrumentos de avaliação pode contribuir para melhorar a abordagem da Enfermagem, e em consequência, o bem-estar e a qualidade de vida destas pessoas.

The impact of exercise intervention for patients undergoing hemodialysis on fatigue and quality of life: A protocol for systematic review and meta-analysis

BACKGROUND

This study aims to determine the therapeutic efficacy of exercise interventions for patients undergoing hemodialysis (HD) on fatigue and health-related quality of life (HRQoL).

METHODS

This review will only include randomized controlled trials (RCTs). The search strategy will be performed in 4 English databases, 4 Chinese databases, Clinical Trials.gov, and the Chinese Clinical Trial Registry. All English or Chinese RCTs, published from inception to May 31, 2020, will be sought. Two reviewers will screen, select studies, extract data, and assess quality independently. Primary outcome is fatigue assessed by questionnaire. The methodological quality including the risk of bias of the included studies will be evaluated using the Physiotherapy Evidence Database scale. Stata 12.0 software will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis.

RESULTS

We will provide some more practical and targeted results investigating the effect of exercise interventions for patients undergoing HD on fatigue and HRQoL in the current meta-analysis, and point out the main limitation of previous studies.

CONCLUSION

The study will provide recent evidence for evaluating the therapeutic efficacy of exercise interventions for patients undergoing HD on fatigue and HRQoL.

REGISTRATION NUMBER

INPLASY202050071 (DOI: 10.37766/inplasy2020.5.0071).

Impact of hemodialysis and post-dialysis period on granular activity levels

Background

Physical activity (PA) is typically lower on hemodialysis (HD) days. Albeit intradialytic inactivity is expected, it is unknown whether recovery after HD contributes to low PA. We investigated the impact of HD and post-HD period on granular PA relative to HD timing.

Methods

We used baseline data from the HDFIT trial conducted from August 2016 to October 2017. Accelerometry measured PA over 1 week in patients who received thrice-weekly high-flux HD (vintage 3 to 24 months), were clinically stable, and had no ambulatory limitations. PA was assessed on HD days (0 to ≤24 h after start HD), first non-HD days (> 24 to ≤48 h after start HD) and second non-HD day (> 48 to ≤72 h after start HD). PA was recorded in blocks/slices: 4 h during HD, 0 to ≤2 h post-HD (30 min slices), and > 2 to ≤20 h post-HD (4.5 h slices). Blocks/slices of PA were captured at concurrent/parallel times on first/second non-HD days compared to HD days.

Results

Among 195 patients (mean age 53 ± 15 years, 71% male), step counts per 24-h were 3919 ± 2899 on HD days, 5308 ± 3131 on first non-HD days (p < 0.001), and 4926 ± 3413 on second non-HD days (p = 0.032). During concurrent/parallel times to HD on first and second non-HD days, patients took 1308 and 1128 more steps (both p < 0.001). Patients took 276 more steps and had highest rates of steps/hour 2-h post-HD versus same times on first non-HD days (all p < 0.05). Consistent findings were observed on second non-HD days.

Conclusions

PA was higher within 2-h of HD versus same times on non-HD days. Lower PA on HD days was attributable to intradialytic inactivity. The established PA profiles are of importance to the design and development of exercise programs that aim to increase activity during and between HD treatments.

Trial registration

HDFIT was prospectively registered 20 April 2016 on ClinicalTrials.gov (NCT02787161)

Evaluating symptom burden in kidney transplant recipients: validation of the revised Edmonton Symptom Assessment System for kidney transplant recipients - a single-center, cross-sectional study

We assessed the validity of the Edmonton Symptom Assessment System (ESAS-r) in kidney transplant recipients (KTR). A cross-sectional sample of 252 KTR was recruited. Individual ESAS-r symptom scores and symptom domain scores were evaluated. Internal consistency, convergent validity, and construct validity were assessed with Cronbach's α, Spearman's rank correlations, and a priori-defined risk group comparisons. Mean (SD) age was 51 (16), 58% were male, and 58% Caucasian. ESAS-r Physical, Emotional, and Global Symptom Scores demonstrated good internal consistency (α > 0.8 for all). ESAS-r Physical and Global Symptom Scores strongly correlated with PHQ-9 scores (0.72, 95% CI: 0.64-0.78 and 0.74, 95% CI: 0.67-0.80). For a priori-defined risk groups, individual ESAS-r symptom score differed between groups with lower versus higher eGFR [pain: 1 (0-3) vs. 0 (0-2), delta = 0.18; tiredness: 3 (1-5) vs. 1.5 (0-4), delta = 0.21] and lower versus higher hemoglobin [tiredness: 3 (1-6) vs. 2 (0-4), delta = 0.27]. ESAS-r Global and Physical Symptom Scores differed between groups with lower versus higher hemoglobin [13 (6-29) vs. 6.5 (0-18.5), delta = 0.3, and 9 (2-19) vs. 4 (0-13), delta = 0.24] and lower versus higher eGFR [11 (4-20) vs. 6.5 (2-13), delta = 0.21, and 7 (2-16) vs. 3 (0-9), delta = 0.26]. These data support reliability and construct validity of ESAS-r in KTR. Future studies should explore its clinical utility for symptom assessment among KTR.