TY - JOUR
T1 - Fatigue in Patients Receiving Maintenance Hemodialysis
T2 - A Review
AU - Bossola, Maurizio
AU - Hedayati, S. Susan
AU - Brys, Astrid D.H.
AU - Gregg, L. Parker
N1 - Funding Information:
Dr Gregg is supported by a VA Clinical Sciences Research & Development Career Development Award (IK2CX002368). This work was supported in part by the Houston VA Health Services Research & Development Center for Innovations grant (CIN13-413). Dr Hedayati is supported by grants 3R01DK124379-03S1 and R01DK124379 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Drs Bossola and Brys declare no funds received for this work. The funding sources did not have a role in defining the content of this article.
Publisher Copyright:
© 2023 National Kidney Foundation, Inc.
PY - 2023/10
Y1 - 2023/10
N2 - Fatigue surrounding hemodialysis treatments is a common and often debilitating symptom that impacts patients’ quality of life. Intradialytic fatigue develops or worsens immediately before hemodialysis and persists through the dialysis treatment. Little is known about associated risk factors or pathophysiology, although it may relate to a classic conditioning response. Postdialysis fatigue (PDF) develops or worsens after hemodialysis and may persist for hours. There is no consensus on how to measure PDF. Estimates for the prevalence of PDF range from 20%-86%, likely due to variation in methods of ascertainment and participant characteristics. Several hypotheses seek to explain the pathophysiology of PDF, including inflammation, hypothalamic-pituitary-adrenal axis dysregulation, and osmotic and fluid shifts, but none is currently supported by compelling or consistent data. PDF is associated with several clinical factors, including cardiovascular and hemodynamic effects of the dialysis procedure, laboratory abnormalities, depression, and physical inactivity. Clinical trials have reported hypothesis-generating data about the utility of cold dialysate, frequent dialysis, clearance of large middle molecules, treatment of depression, and exercise as potential treatments. Existing studies are often limited by sample size, lack of a control group, observational design, or short intervention duration. Robust studies are needed to establish the pathophysiology and management of this important symptom.
AB - Fatigue surrounding hemodialysis treatments is a common and often debilitating symptom that impacts patients’ quality of life. Intradialytic fatigue develops or worsens immediately before hemodialysis and persists through the dialysis treatment. Little is known about associated risk factors or pathophysiology, although it may relate to a classic conditioning response. Postdialysis fatigue (PDF) develops or worsens after hemodialysis and may persist for hours. There is no consensus on how to measure PDF. Estimates for the prevalence of PDF range from 20%-86%, likely due to variation in methods of ascertainment and participant characteristics. Several hypotheses seek to explain the pathophysiology of PDF, including inflammation, hypothalamic-pituitary-adrenal axis dysregulation, and osmotic and fluid shifts, but none is currently supported by compelling or consistent data. PDF is associated with several clinical factors, including cardiovascular and hemodynamic effects of the dialysis procedure, laboratory abnormalities, depression, and physical inactivity. Clinical trials have reported hypothesis-generating data about the utility of cold dialysate, frequent dialysis, clearance of large middle molecules, treatment of depression, and exercise as potential treatments. Existing studies are often limited by sample size, lack of a control group, observational design, or short intervention duration. Robust studies are needed to establish the pathophysiology and management of this important symptom.
KW - Fatigue
KW - hemodialysis
KW - intradialytic fatigue
KW - postdialysis fatigue
U2 - 10.1053/j.ajkd.2023.02.008
DO - 10.1053/j.ajkd.2023.02.008
M3 - (Systematic) Review article
C2 - 37187283
SN - 0272-6386
VL - 82
SP - 464
EP - 480
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 4
ER -