Hemodialysis fatigue: just "simple" fatigue or a syndrome on its own right?

The influence of social support on sleep and fatigue level among patients receiving hemodialysis in Saudi Arabia: a cross-sectional correlational design

Background

Patients on hemodialysis (HD) are more likely to experience sleep problems and fatigue that may affect their health outcomes. Management of these patients with social support may improve their sleep quality and fatigue as well as their health.

Aim

This study aimed to assess the influence of social support on sleep quality and fatigue levels among HD patients.

Methods

A cross-correlational study was conducted among 260 conveniently sampled HD patients from four dialysis centers in Hail and Al-Qassim cities of Saudi Arabia from Jun 2022 to January 2023. Besides sociodemographic data, the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Assessment of Fatigue (MAF) and the Oslo Social Support Scale (OSSS-3) were used to assess sleep quality, fatigue levels and social support, respectively. Chi-square test was used to determine the association between categorical variables, while Pearson's correlation coefficient was used to test the correlation between sleep quality, fatigue, and social support.

Results

Poor sleep and high fatigue were significantly higher in older patients compared to younger patients (p <0.001), while strong social support was significantly lower in older patients than younger and middle-aged ones (p = 0.001). On the other hand, poor sleep and high fatigue were significantly higher in males than females (p = 0.022 and p <0.001, respectively), while strong social support was significantly higher in females than males (p <0.001). Married patients showed significantly poorer sleep than single ones (p = 0.019), but single patients received significantly stronger social support. Retired patients showed significantly poorer sleep, higher fatigue and weaker social support than other groups (p <0.001). There was a significant negative correlation between fatigue and sleep quality among HD patients, where patients with more fatigue had poorer sleep (r = -0.510, p <0.001). A significant positive correlation was found between social support and sleep quality, where patients with stronger social support had more normal sleep (r = 0.415, p <0.001). However, a significant negative correlation was found between social support and fatigue, where patients with stronger social support had lower levels of fatigue (r = -0.479, p <0.001).

Conclusion

Saudi patients on HD who have stronger social support have better sleep quality and reduced fatigue levels than those with less social support. There is a need to design and implement intervention studies with structured social support programs, and to evaluate their effectiveness on improving sleep and reducing fatigue among HD patients.

Novel Approach to Intradialytic Progressive Resistance Exercise Training

Physical activity levels are typically undesirably low in chronic kidney disease patients, especially in those undergoing haemodialysis, and particularly on dialysis days. Intradialytic exercise programmes could be a solution to this issue and have been reported to be safe and relatively easily implemented in dialysis clinics. Nevertheless, such implementation has been failing in part due to barriers such as the lack of funding, qualified personnel, equipment, and patient motivation. Intradialytic aerobic exercise has been the most used type of intervention in dialysis clinics. However, resistance exercise may be superior in eliciting potential benefits on indicators of muscle strength and mass. Yet, few intradialytic exercise programmes have focused on this type of intervention, and the ones which have report inconsistent benefits, diverging on prescribed exercise intensity, absent or subjective load progression, equipment availability, or exercise supervision. Commonly, intradialytic resistance exercise interventions use free weights, ankle cuffs, or elastic bands which hinder load progression and exercise intensity monitoring. Here, we introduce a recently developed intradialytic resistance exercise device and propose an accompanying innovative resistance exercise training protocol which aims to improve the quality of resistance exercise interventions within dialysis treatment sessions.

Health-related quality of life of dialysis patients during early COVID-19 lockdowns: a snapshot from a public hospital in Malaysia

Background

End-stage renal disease is the last stage of chronic kidney disease and can affect the quality of life (QOL) of dialysis patients. The aim of this study was to assess the quality of life and examine its determinants.

Methods

A cross-sectional survey involving patients on dialysis in a tertiary hospital was conducted from July 2020 to September 2020. Demographic data were collected using a predesigned questionnaire. QOL was measured using the 36-item KDQOL questionnaire, and statistical analysis was carried out using SPSS version 25.

Results

Of the 108 patients, 59 were men and 49 were women, and the mean age was 48.15 ± 15.4 years. The results showed that there was no significant difference in the mean score of all components of health-related quality of life in different types of dialysis. The demographic data, which included age, gender, ethnicity, marital status, education level, occupation, and monthly income, did not significantly affect the QOL of dialysis patients. Patients with a dialysis duration of more than 5 years had a better QOL compared to other groups. Laboratory parameters such as low albumin and low hemoglobin showed a significant correlation with the health-related quality of life of dialysis patients.

Conclusion

The quality of life among patients on dialysis was impaired, especially in terms of burden of the kidney disease. Hypoalbuminemia and anemia were the two factors that influenced QOL.

The Lived Self-Care Experiences of Patients Undergoing Long-Term Haemodialysis: A Phenomenological Study

The study aims to understand the lived self-care experiences of patients who have undergone long-term haemodialysis. The study adopts a qualitative phenomenological design. Data were collected for six months, from 1 July to 31 December 2020. Out of 90 outpatients in a haemodialysis clinic at a university hospital in Seoul, Korea, 11 patients who had received haemodialysis for more than 10 years were purposefully selected, and 9 of them took part in in-depth interviews. The main research question was, 'What was the experience of surviving long-term haemodialysis?' The study revealed four main themes surrounding the topic of self-care: (A) the desire to keep living despite challenges, (B) creating one's own dietary principles, (C) moving one's body with the remaining strength, and (D) moving toward independence. In the long-term self-care of haemodialysis patients, they shared personal observations on their disease and treatment process and their struggles to try to manage their own physical and emotional self-care. By exploring the experience of long-term haemodialysis, it is possible to gain a deeper understanding of their perceptions, emotions, and motivations. With this information, healthcare professionals can develop interventions and support strategies that are tailored to the specific needs of haemodialysis patients.

The effect of a 9-month hybrid intradialytic exercise training program on nerve conduction velocity parameters in patients receiving hemodialysis therapy

INTRODUCTION AND AIMS

Neurological complications such as peripheral neuropathy are very common in the end-stage renal disease (ESRD) patients, occurring in 60-80% of this specific population. The aim of the present study was to examine whether a 9-month hybrid intradialytic exercise training program could alter motor and sensory nerve conduction study (NCS) parameters in hemodialysis population.

METHODS

Seventeen stable patients undergoing HD with no clinical evidence of uremic polyneuropathy were included in the study (15 M/2F, 59 ± 13.7 years). All patients completed a 9-month supervised exercise training program composed of both aerobic cycling and resistance training (hybrid) during HD. Functional capacity was assessed by a battery of tests, while pain levels and fatigue profile were assessed via validated questionnaires. Motor and sensory NCS on bilateral median, ulnar, peroneal and tibial nerves as well as F-wave were assessed using a full neurographic electromyography (EMG) assessment.

RESULTS

After the 9-month exercise training intervention, exercise capacity was increased by 65% and functional capacity by an average of 40%. The neurological assessment showed that conduction velocity from tibial and peroneal nerves was improved by 3.7% and 4.2%, respectively, while tibial F-wave latency and peroneal and sural nerve distal latency were significantly improved by 4.2%, 4.9% and 10%, respectively. Fatigue and pain were improved after the exercise intervention while fatigue score was positively correlated with conduction velocity and amplitude values.

CONCLUSIONS

The results of the current study demonstrate that 9-month hybrid exercise training induces beneficial effects on both sensory and motor NCS parameters, improving conduction velocity and F-wave latency. Improvements in neural activity were accompanied by changes in fatigue score and pain-related aspects. The parallel improvement in motor nerve conduction velocity and its correlations with functional tests supports the hypothesis that exercise could be beneficial for preventing a decline in neural function in HD patients.

Factors Associated With Fatigue in Patients Undergoing Hemodialysis

Background and objective

Fatigue is frequently experienced by patients undergoing hemodialysis and it has a negative effect on their quality of life. The aim of this study was to investigate the factors associated with fatigue in patients undergoing hemodialysis.

Methods

In this quantitative cross-sectional study, 100 patients on hemodialysis participated. Fatigue was evaluated via the Modified Fatigue Impact Scale (MFIS). Participants also completed a questionnaire about demographics and clinical characteristics. The Kruskal-Wallis test, the Mann-Whitney U test, and Spearman's rho criterion were used to assess the association between fatigue score and patient characteristics. Multiple linear regression was performed to assess the effect of the characteristics on patients' fatigue.

Results

Statistically significant high levels of physical or mental fatigue were found in older patients (p=0.001 and p=0.001), divorced/widowed patients (p=0.001 and p=0.014), those who had children (p=0.019), those who had primary education (p=0.015), those who were not informed about their health problems (p=0.003 and p=0.006), those who had comorbid diseases (p=0.001 and p=0.001), those who believed that regular information did not help to reduce stress (p=0.005 and p=0.004), patients who had insomnia (p=0.001 and p=0.001), patients who felt tired after hemodialysis (p=0.001 and p=0.001), those who thought they had a change in body image (p=0.001 and p=0.001), those who often felt stiffness (p=0.001 and p=0.001), those who sometimes felt nausea (p=0.015 and p=0.038), and those who had limitations in the clothes they could wear (p=0.001 and p=0.001).

Conclusions

The findings of this study showed that physical or mental fatigue had a strong association with advanced age, comorbidities, marital status, level of education, inadequate information about the disease, insomnia, and change in body appearance. Hence, renal professionals need to properly educate dialysis patients on the complicated nature of fatigue in order to manage it effectively and improve their physical, cognitive, and social wellbeing.

Long-term intradialytic hybrid exercise training on fatigue symptoms in patients receiving hemodialysis therapy

PURPOSE

Hemodialysis (HD) patients suffer from generalized weakness, exercise intolerance and muscle atrophy, all leading to generalized fatigue and lack of energy. HD patients spend at least 50% of their time in a functionally "switch off" mode with their fatigue sensations reaching a peak in the immediate hours after the dialysis session. The purpose of the current study was to assess the effectiveness of a nine-month hybrid intradialytic exercise program on fatigue symptoms occurring during and after hemodialysis session.

METHODS

Twenty stable hemodialysis patients were included in the study (59 ± 13.7 years; 16 males). All patients completed a 9-month supervised exercise training program composed of both aerobic cycling and resistance training during HD. Aspects related to physical and generalized fatigue were assessed via validated questionnaires, while physical performance was assessed by a battery of tests, before and after the intervention period.

RESULTS

Exercise capacity and physical performance were increased by an average of 65 and 40%, respectively. Patients reported feeling better during post-dialysis hours in question 1 (p = 0.000), question 3 (p = 0.009) and question 4 (p = 0.003) after the 9-month intervention. In addition, exercise training improved scores in cognitive function (p = 0.037), vitality (p = 0.05), depression (p = 0.000) and fatigue (p = 0.039).

CONCLUSION

The present study showed that a 9-month hybrid (aerobic + resistance) exercise training program improved symptoms of post-dialysis fatigue and overall general perception of fatigue. Hybrid exercise training is a safe and effective non-pharmacological approach to ameliorate fatigue symptoms in HD patients.

TRIAL REGISTRATION NUMBER

Trial registration number The study is registered at ClinicalTrials.gov (NCT01721551, 2012) as a clinical trial.

Effects of 12 months of detraining on health-related quality of life in patients receiving hemodialysis therapy

PURPOSE

Limited data exist regarding the effects of detraining on functional capacity and quality of life (QoL) in the hemodialysis population. The aim of the current study was to assess whether the discontinuation from a systematic intradialytic exercise training program will affect aspects of health-related QoL and functional capacity in hemodialysis patients.

METHODS

Seventeen hemodialysis patients (12 Males/5 Females, age 60.8 ± 13.6 year) participated in this study. Patients were assessed for functional capacity using various functional capacity tests while QoL, daily sleepiness, sleep quality, depression and fatigue were assessed using validated questionnaires at the end of a 12-month aerobic exercise program and after 12 months of detraining.

RESULTS

The detraining significantly reduced patients' QoL score by 20% (P = 0.01). More affected were aspects related to the physical component summary of the QoL (P < 0.001) rather than those related to the mental one (P = 0.096). In addition, the performance in the functional capacity tests was reduced (P < 0.05), while sleep quality (P = 0.020) and daily sleepiness scores (P = 0.006) were significantly worse after the detraining period. Depressive symptoms (P = 0.214) and the level of fatigue (P = 0.163) did not change significantly.

CONCLUSIONS

Detraining has a detrimental effect in patients' QoL, functional capacity and sleep quality. The affected physical health contributed significantly to the lower QoL score. It is crucial for the chronic disease patients, even during emergencies such as lockdowns and restrictions in activities to maintain a minimum level of activity to preserve some of the acquired benefits and maintain their health status.

Haemodialysis patients' experience with fatigue: a phenomenological study

Fatigue is one of the main and serious problems that affects haemodialysis patients' quality of life. It should be actively evaluated and, in this process, cooperation between the patient, their family, and healthcare staff is needed to examine fatigue and improve the quality of healthcare and the patient's life. The aim of the present research was to investigate haemodialysis patients' experiences of fatigue. In this qualitative phenomenological study, 12 participants were selected from haemodialysis patients in two health centres in Iran through purposeful sampling. Data were collected through semi-structured in-depth interviews and the collected data were analysed using Colaizzi's method. Two main themes, the nature of fatigue and the perception of fatigue, were found. In addition, the results revealed six secondary themes: physical problems, psychosocial problems, behavioural problems, limitations, need for support, and burnout. The results help to clarify the concept and nature of fatigue for this group of haemodialysis patients.

Association between fatigue, motivational measures (BIS/BAS) and semi-structured psychosocial interview in hemodialytic treatment

Background

Nowadays there is a growing interest in exploring causes of fatigue symptoms and the possible linked aspects in patients with Chronic Kidney Disease (CKD) receiving hemodialysis (HD) treatment. Inflammatory processes were demonstrated to influence motivational systems functioning in chronic conditions. However, there is a lack of connection between quantitative motivational systems measure and patients self-report motivational and fatigue issue. Thus, the aim of this study was to identify an association between HD patients reward mechanisms, fatigue severity and psychosocial variables emerging from semi-structured interviews.

Methods

Interviews were held for a sample of ninety-four patients (54 males, 40 females; M_age = 62.98 ± 17.94; dialytic mean age in months = 76.55 ± 84.89) receiving chronic HD treatment and consequently analyzed by means of quantitative and qualitative analysis. Behavioral motivation systems reflecting inhibition/approach tendency to rewards were measured by Behavioral Inhibition/Activation System (BIS/BAS) scale and the fatigue severity experienced by HD patients was measured with the Fatigue Severity Scale. Scale results were correlated to psychosocial variables and topics derived from the semi-structured interviews.

Results

Findings highlight the presence of two effects: one related to the Behavioral Activation System (BAS) as a protective factor against the HD treatment pervasive consequences; the other one deals with the self-reported levels of fatigue that seemed to significantly interfere with patients’ daily life, as a function of gender.

Conclusions

Such results encourage the use of a mixed method approach to understand the complexity of the subjective experience of patients’ facing chronic disease and treatments.

Attitudes of hemodialysis patients, medical and nursing staff towards patients' physical activity

PURPOSE

Patients with end-stage renal disease (ESRD) seem to have a negative attitude towards physical activity, which is mainly favored by the lack of counseling provided by the medical and nursing staff. The aim of this study was to investigate the attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity and identify the obstacles that discourage patients' involvement in intervention programs.

STUDY DESIGN

Subjective assessment questionnaires and the International Physical Activity Questionnaire were administrated to hemodialysis patients and medical staff, to investigate the association between patient's barriers to physical activity, the total intensity level of physical activity, and attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity.

RESULTS

A total of 103 ESRD patients (61 men, 59.2%), 20 nephrologists (12 men, 60.0%), and 72 nurses (61 women, 84.7%) participated in the study. Most commonly reported patient's barriers were fatigue on dialysis (97.4%) and non-dialysis days (55.1%). Healthcare staff showed positive attitude towards renal rehabilitation exercise programs. However, most of physicians (85.0%) and nurses (83.3%) did not have previous experience with interventional exercise rehabilitation programs. Binary logistic regression revealed significant association between patients' inactivity, demographic data, and barriers towards physical activity, such as fatigue and pain in dialysis and non-dialysis days (p < 0.05), family's and physician's concern (p < 0.05), too many medical problems (p < 0.05), the fear of getting hurt (p = 0.01), and unwillingness for exercise (p < 0.05). Interestingly, healthcare staff's negative attitudes toward patient's physical activity seem to be strongly associated with patient's inactivity status.

CONCLUSION

Healthcare staff negative attitudes and multiple related barriers especially fatigue on dialysis and non-dialysis days, towards ESRD patient's physical activity, suppress desire for exercise and active patients' status, leading them to abstain from it.

Exploring the Diurnal Course of Fatigue in Patients on Hemodialysis Treatment and Its Relation With Depressive Symptoms and Classical Conditioning

CONTEXT

Fatigue is one of the most prevalent symptoms among hemodialysis (HD) patients. To design effective treatments, it is crucial to understand the diurnal pattern of fatigue in this population.

OBJECTIVES

The objectives of this study were to assess diurnal changes in fatigue in patients undergoing hemodialysis and their relation with depressive symptoms and to explore whether fatigue may become a classically conditioned response to the hospital environment.

METHODS

A prospective, observational study was conducted in 51 HD patients. Subjects repeatedly rated their current fatigue on three different days during one week of hemodialysis treatment to capture changes in momentary fatigue. First, on an HD treatment day, fatigue was measured one hour before and immediately before dialysis, as well as immediately after dialysis and again at 22:00 pm Second, on the postdialysis day and on the seventh weekday (when patients had not received treatment on the previous day), fatigue was measured at the same moments in time as the two measurements before dialysis on the treatment day. Beck Depression Inventory-II and Fatigue Severity Scale were administered to evaluate depressive mood and fatigue severity in daily life.

RESULTS

Fatigue increased as a result of hemodialysis treatment over the entire sample. However, diurnal fatigue patterns differed significantly between individuals high and low in depressive symptoms, with the former being fatigued more constantly throughout the day, and the latter experiencing increases in fatigue due to treatment. Pretreatment fatigue experienced in the hospital environment followed a pattern consistent with the development of a classically conditioned response.

CONCLUSION

Diurnal fatigue patterns during hemodialysis treatment are associated with depressive symptoms, and classical conditioning may play a role in the experience of pretreatment fatigue.

Monitoring Exercise-Induced Muscle Fatigue and Adaptations: Making Sense of Popular or Emerging Indices and Biomarkers

Regular exercise with the appropriate intensity and duration may improve an athlete’s physical capacities by targeting different performance determinants across the endurance–strength spectrum aiming to delay fatigue. The mechanisms of muscle fatigue depend on exercise intensity and duration and may range from substrate depletion to acidosis and product inhibition of adenosinetriphosphatase (ATPase) and glycolysis. Fatigue mechanisms have been studied in isolated muscles; single muscle fibers (intact or skinned) or at the level of filamentous or isolated motor proteins; with each approach contributing to our understanding of the fatigue phenomenon. In vivo methods for monitoring fatigue include the assessment of various functional indices supported by the use of biochemical markers including blood lactate levels and more recently redox markers. Blood lactate measurements; as an accompaniment of functional assessment; are extensively used for estimating the contribution of the anaerobic metabolism to energy expenditure and to help interpret an athlete’s resistance to fatigue during high intensity exercise. Monitoring of redox indices is gaining popularity in the applied sports performance setting; as oxidative stress is not only a fatigue agent which may play a role in the pathophysiology of overtraining syndrome; but also constitutes an important signaling pathway for training adaptations; thus reflecting training status. Careful planning of sampling and interpretation of blood biomarkers should be applied; especially given that their levels can fluctuate according to an athlete’s lifestyle and training histories.

Assessment of Fatigue in End Stage Renal Disease Patients Undergoing Hemodialysis: Prevalence and Associated Factors

Background:

Fatigue is a common symptom referred by many patients undergoing hemodialysis. Fatigue is associated with poor health-related quality of life (HRQoL) and is an important predictor for survival of hemodialysis patients.

Aim:

To assess the levels of fatigue and demographic factors affecting it among patients with End Stage Renal Disease undergoing hemodialysis.

Methods:

This quantitative study was carried out in two Dialysis Units of Hospitals in Athens Region. Between January 2015 and June 2015, 129 hemodialysis patients completed the Greek Version of the Fatigue Assessment Scale (FAS). Demographic data of patients was recorded. For the statistical analysis IBM SPSS Statistics version 20 was used.

Results:

The mean FAS score was 24.99. 49 patients (38.0%) were non fatigued, 61 patients (47.3%) were fatigued, and 19 patients (13.7%) were extremely fatigued. Higher levels of fatigue were reported among hemodialysis patients residing in urban areas, in those with low educational level and unemployed.

Conclusion:

The findings of this study can be used in the assessment of fatigue and early identification of high-risk patients (especially of the unemployed, those who occupy with domestic works, those with low educational level and of urban citizens). Use of this knowledge by hemodialysis nurses may lead to a better understanding of the factors of fatigue in ESRD, which in turn may lead to a more effective treatment.

Establishing a Core Outcome Measure for Fatigue in Patients on Hemodialysis: A Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop Report

Fatigue is one of the most highly prioritized outcomes for patients and clinicians, but remains infrequently and inconsistently reported across trials in hemodialysis. We convened an international Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) consensus workshop with stakeholders to discuss the development and implementation of a core outcome measure for fatigue. 15 patients/caregivers and 42 health professionals (clinicians, researchers, policy makers, and industry representatives) from 9 countries participated in breakout discussions. Transcripts were analyzed thematically. 4 themes for a core outcome measure emerged. Drawing attention to a distinct and all-encompassing symptom was explicitly recognizing fatigue as a multifaceted symptom unique to hemodialysis. Emphasizing the pervasive impact of fatigue on life participation justified the focus on how fatigue severely impaired the patient's ability to do usual activities. Ensuring relevance and accuracy in measuring fatigue would facilitate shared decision making about treatment. Minimizing burden of administration meant avoiding the cognitive burden, additional time, and resources required to use the measure. A core outcome measure that is simple, is short, and includes a focus on the severity of the impact of fatigue on life participation may facilitate consistent and meaningful measurement of fatigue in all trials to inform decision making and care of patients receiving hemodialysis.

Restless legs syndrome is contributing to fatigue and low quality of life levels in hemodialysis patients

AIM

To examine whether hemodialysis (HD) patients with restless legs syndrome (RLS) are subjects of greater fatigue and impaired quality of life (QoL) compared to HD patients without RLS.

METHODS

Eighty five stable HD patients participated in this study. According to their RLS status, the patients were divided into the RLS group (n = 23) and the non-RLS group (n = 62). QoL, fatigue, sleep quality, daily sleepiness and depression symptoms were assessed by using various questionnaires. Finally, biochemical parameters including iron, ferritin, hemoglobin, hematocrit and parathormone were assessed.

RESULTS

The HD patients with RLS scored worse in all the questionnaires used in the study (P < 0.05). The patients with RLS were more likely to receive the HD therapy on the morning shift, whilst 43.5% of the RLS patients reported to experience the RLS symptoms also during HD. The severity of RLS was correlated with fatigue, depression score and sleep quality (P < 0.05).

CONCLUSION

HD patients with RLS are subject to lower QoL related parameters and greater fatigue compared to HD patients without RLS. RLS should be successfully managed in order to improve the QoL of the sufferers.

Factors associated with leisure-time physical activity among patients undergoing hemodialysis

BACKGROUND

End-stage renal disease patients are characterized by low levels of physical activity, especially during leisure time. However, the recognition of variables associated with patterns of physical activity in this population has been little explored. Thus, the objective was to assess factors associated with levels of physical activity during leisure time among patients on haemodialysis.

METHODS

Ninety-eight patients (51.6 ± 15.7 years, 57 M/41 F) from two dialysis centres in São Paulo, Brazil participated in this cross-sectional study. Participants were divided into those who never exercised during leisure-time (inactive) and those who exercised at least once a week (active). The independent factors assessed were: socio-demographic data, comorbidities, personal barriers to exercise and physical activity records from childhood to adulthood (tracking of physical activity).

RESULTS

Only 27 % of patients were engaged in PA during their leisure time at least once a week. Patients who engaged in regular physical activity during adulthood before the initiation of the hemodialysis treatment (adjusted OR: 7.24 95 % IC: 1.99; 26.50), those who developed the renal disease through diseases other than diabetes or hypertension (adjusted OR: 4.82; 95 % IC: 1.48; 15.68), and those who had no cardiovascular diseases (adjusted OR: 11.33; 95 % IC: 1.23; 103.8) where more likely to be active during their leisure-time.

CONCLUSION

Comorbidities such as cardiovascular disease, hypertension and diabetes mellitus as well as the level of physical activity prior to end-stage renal disease could predict leisure-time physical activity among patients receiving hemodialysis therapy.

A narrative review on the similarities and dissimilarities between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and sickness behavior

It is of importance whether myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a variant of sickness behavior. The latter is induced by acute infections/injury being principally mediated through proinflammatory cytokines. Sickness is a beneficial behavioral response that serves to enhance recovery, conserves energy and plays a role in the resolution of inflammation. There are behavioral/symptomatic similarities (for example, fatigue, malaise, hyperalgesia) and dissimilarities (gastrointestinal symptoms, anorexia and weight loss) between sickness and ME/CFS. While sickness is an adaptive response induced by proinflammatory cytokines, ME/CFS is a chronic, disabling disorder, where the pathophysiology is related to activation of immunoinflammatory and oxidative pathways and autoimmune responses. While sickness behavior is a state of energy conservation, which plays a role in combating pathogens, ME/CFS is a chronic disease underpinned by a state of energy depletion. While sickness is an acute response to infection/injury, the trigger factors in ME/CFS are less well defined and encompass acute and chronic infections, as well as inflammatory or autoimmune diseases. It is concluded that sickness behavior and ME/CFS are two different conditions.