Fatigue in persons with renal failure who require maintenance haemodialysis

Development and validation of a nomogram model for accurately predicting severe fatigue in maintenance hemodialysis patients: A multicenter cross-sectional study in China

INTRODUCTION

This study aims to analyze the risk factors for severe fatigue in maintenance hemodialysis (MHD) patients and develop a clinical prediction model to help doctors and patients prevent severe fatigue.

METHODS

Multicentre MHD patients were included in this study. The objective was to investigate the risk factors for severe fatigue in MHD patients and develop a prediction model.

RESULTS

A total of 243 MHD patients were included in the study, and the incidence of severe fatigue was found to be 20.99%. Using age, body mass index, total cholesterol, and albumin levels, a predictive nomogram for fatigue was constructed. In the training set, the nomogram had an area under the curve of 0.851, sensitivity of 82.86%, specificity of 81.76%, and c-index of 0.851. The nomogram was accurate in calibration and proved to be clinically useful.

CONCLUSION

The nomogram developed in this study is a practical and reliable tool for quickly identifying severe fatigue in MHD patients.

Dialysis recovery time: associated factors and its association with quality of life of hemodialysis patients

Introduction

Post-dialysis fatigue is a common and distressing complaint in patients on hemodialysis (HD). The dialysis recovery time (DRT) is a recent and reliable method of Post-dialysis fatigue assessment. We aimed to identify factors affecting the DRT and its relation with HD patients’ quality of life.

Material and methods

This is a cross-sectional study carried out on end-stage renal disease patients on regular HD. All participants underwent detailed history taking and complete physical examination, and data on dialysis and laboratory investigations were also collected. Patients were asked “How long does it take you to recover from a dialysis session?” to calculate the DRT. We used the Malnutrition-Inflammation Score (MIS) and KDQOL-36 questionnaire to assess patients’ nutritional status and quality of life, respectively.

Results

Two hundred and ten patients were screened and 191, with a median age of 47 years, completed the study. Patients had a median DRT of 300 minutes (range: 0.0–2880.0), with 55% of patients reporting a DRT of > 240 minutes and 22.5% of them reporting a DRT of < 30 minutes. Patients had a median MIS score of 7 (range: 0–17). There was a statistically significant negative relation between the DRT and symptom/ problem list (p < 0.001), effects of kidney disease (p < 0.001), burden of kidney disease (p < 0.001), SF-12 physical composite (p = 0.001), and SF-12 mental composite (p < 0.001) of KDQOL. The results of multivariate analyses showed that dialysate Na (p = 0.003), and the number of missed sessions (p < 0.001) were independently correlated with the DRT.

Conclusions

Decreased dialysate Na, and increased number of missed sessions were predictors of prolonged DRT. Patients with prolonged DRT were associated with poorer quality of life. Further randomized clinical trials are needed to assess strategies to minimize the DRT and, perhaps, enhance clinical outcomes.

Trials registration

ClinicalTrials.gov Identifier: NCT04727281. First registration date: 27/01/2021.

New Insight Concerning Therapeutic Drug Monitoring-The Importance of the Concept of Psychonephrology

Recently, the concept of psychonephrology was developed and has been recognized as a field of study that focuses on nephrology and mental health fields, such as psychiatry and psychosomatic medicine. Indeed, patients with chronic kidney disease frequently suffer from mental problems as the disease stage progresses. Most psychotropic drugs are hepatically metabolized, but some are unmetabolized and eliminated renally. However, renal disease may affect the pharmacokinetics of many psychotropic drugs, as the decreased renal function not only delays the urinary excretion of the drug and its metabolites but also alters various pharmacokinetic factors, such as protein-binding, enterohepatic circulation, and activity of drug-metabolizing enzymes. Therefore, when prescribing drug therapy for patients with both renal disease and mental issues, we should consider reducing the dosage of psychotropic drugs that are eliminated mainly via the kidney and also carefully monitor the blood drug concentrations of other drugs with a high extrarenal clearance, such as those that are largely metabolized in the liver. Furthermore, we should carefully consider the dialyzability of each psychotropic drug, as the dialyzability impacts the drug clearance in patients with end-stage renal failure undergoing dialysis. Therapeutic drug monitoring (TDM) may be a useful tool for adjusting the dosage of psychotropic drugs appropriately in patients with renal disease. We herein review the pharmacokinetic considerations for psychotropic drugs in patients with renal disease as well as those undergoing dialysis and offer new insight concerning TDM in the field of psychonephrology.

Contribution of anxiety and dialysis factors to the event of fatigue in hemodialysis patient

Introduction: Fatigue is one of the most common symptoms felt by chronic renal failure patients undergoing hemodialysis (HD). The prevalence ranges from 42-97% with levels varying from low to severe. Fatigue is not only detrimental to physical and social functioning but is also associated with poor quality of life for HD patients and is associated with death in patients undergoing chronic hemodialysis. For this reason, it is necessary to know the factors associated with the incidence of fatigue so that appropriate interventions can be carried out, both pharmacologically and non-pharmacologically.Objective: To evaluate the influence of anxiety and dialysis factors on the incidence of fatigue in patients undergoing hemodialysis at Ciamis Hospital.Material and Method: A cross sectional approach with a total sample of 88 people was used.Results: The results showed that 78 respondents (88.6%) who experienced fatigue complaints and anxiety had a relationship with the incidence of fatigue (OR: 9.0; p=0.019).Conclusions: Psychological factors, such as anxiety, are associated with the fatigue experienced by patients on hemodialysis.

Fatigue Is Not Associated with Phase Angle in Hemodialysis Patients

PURPOSE

The aim of this study was to investigate the association between fatigue and phase angle (PA) in patients with chronic kidney disease (CKD) on hemodialysis (HD).

METHODS

A cross-sectional study with older patients than 18 years diagnosed with CKD undergoing HD. From 160 (58.36±15.05 years) patients, (n=96; 60%) are men. Body mass and height were assessed using a portable scale and stadiometer, followed by body mass index (BMI) calculus. The bioimpedance electrical analysis was performed using the Bodystat QuadScan 4000. The sample size was dichotomized in two groups, using the median of our sample, either normal when PA ≥5.4º, or low when the PA <5.4º. The Chalder fatigue questionnaire was used the assess the fatigue. The multiple regression was applied to assess the association between fatigue questionnaire and PA.

RESULTS

Were considered normal PA≥5.4º (n=78, 48.8%) and low PA<5.4º (n=82, 51.2%). The patients of the PA<5.4º group are older compared to the PA≥5.4º group (63.1±15.1 vs. 53.3±13.4 years, p<0.001). There was no association between PA and fatigue score in the crude model (OR: 1.02, 95%CI: 0.96-1.08, p=0.47) and after confounding variables (OR: 1.03, CI: 0.95-1.12, p=0.43).

CONCLUSIONS

In HD patients, we found that patients with lower PA values are older. In addition, we did not find association between fatigue and PA.

Better health-related quality of life in kidney transplant patients compared to chronic kidney disease patients with similar renal function

Renal functional deterioration is associated with physical and mental burdens for kidney transplant (KT) and chronic kidney disease (CKD) patients. However, the change in health-related quality of life (HRQOL) over time in KT patients compared to that of native CKD patients has not been evaluated. We addressed this issue using KT patients registered in the KNOW-KT cohort study and patients at CKD stage 1–3 registered in the KNOW-CKD cohort study. HRQOL scores were assessed using the Kidney Disease Quality of Life Short Form at baseline, 2-, and 4-years follow-up in 842 KT patients and at baseline and 5-year follow-up in 1,355 CKD patients. SF-36 scores declined at the 4-year follow-up, whereas CKD-targeted scores showed no change in the KT group. In contrast, CKD-targeted scores as well as SF-36 scores were decreased at the 5-year follow-up in CKD patients. When prognostic factors were analyzed for longitudinal HRQOL data over time, renal functions, diabetes, cardiovascular and cerebrovascular diseases, hemoglobin level, marital status, income, employment, and health care were significant prognostic factors. Furthermore, KT was an independent prognostic factor for better HRQOL. These results highlight that KT can offer a better HRQOL than that of CKD patients, even when renal function is similar.

A Systematic Review of Potentially Effective Nonpharmacological Interventions for Reducing Fatigue among Iranian Patients Who Receive Hemodialysis

BACKGROUND AND PURPOSE

Fatigue control in hemodialysis (HD) patients requires a multidisciplinary approach. This study aimed to comprehensively review the available research literature regarding the nonpharmacological interventions used for reducing fatigue among Iranian HD patients.

METHODS

In this systematic review, an extensive search of the literature was conducted on PubMed, Web of Science, and Scopus databases, using the keywords related to the purpose. Also, the Persian equivalent of these keywords was searched in Iranian databases, such as Iranmedex and Scientific Information Database (SID) from the inception to June 16, 2020.

RESULTS

Of 2,761 articles, 25 studies were included in the review. Among a total of 1,748 Iranian HD patients with a mean age of 54.17 (SD = 12.27) years, 61.38% were male. Interventions such as educational-based programs (n = 5), nutrition-based programs (n = 2), massage therapy (n = 3), exercise-based programs (n = 4), relaxation technique (n = 3), combination of relaxation technique and inhalation aromatherapy (n = 1), energy therapy (reflexology and acupressure) (n = 3), and mind-guided imagery (n = 1) were effective in reducing fatigue in Iranian HD patients.

DISCUSSION/CONCLUSION

These simple, low-cost, and practical interventions can be used for the reduction of fatigue among HD patients by nurses. However, future well-designed studies are recommended to confirm the efficacy of these and other potentially effective interventions for reducing fatigue in HD patients.

Clustering of patients with end-stage chronic diseases by symptoms: a new approach to identify health needs

BACKGROUND

End-stage chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and chronic renal failure (CRF) are characterized by a high burden of daily symptoms that, irrespective of the primary organ failure, are widely shared.

AIMS

To evaluate whether and to which extent symptom-based clusters of patients with end-stage COPD, CHF and CRF associate with patients' health status, mobility, care dependency and life-sustaining treatment preferences.

METHODS

255 outpatients with a diagnosis of advanced COPD (n = 95), advanced CHF (n = 80) or CRF requiring dialysis (n = 80) were visited in their home environment and underwent a multidimensional assessment: clinical characteristics, symptom burden using Visual Analog Scale (VAS), health status questionnaires, timed "Up and Go" test, Care Dependency Scale and willingness to undergo mechanical ventilation or cardiopulmonary resuscitation. Three clusters were obtained applying K-means cluster analysis on symptoms' severity assessed via VAS. Cluster characteristics were compared using non-parametric tests.

RESULTS

Cluster 1 patients, with the least symptom burden, had a better quality of life, lower care dependency and were more willing to accept life-sustaining treatments than others. Cluster 2, with a high presence and severity of dyspnea, fatigue, cough, muscle weakness and mood problems, and Cluster 3, with the highest occurrence and severity of symptoms, reported similar care dependency and life-sustaining treatment preferences, while Cluster 3 reported the worst physical health status.

DISCUSSION

Symptom-based clusters identify patients with different health needs and might help to develop palliative care programs.

CONCLUSION

Clustering by symptoms identifies patients with different health status, care dependency and life-sustaining treatment preferences.

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.

Validation of a Core Patient-Reported Outcome Measure for Fatigue in Patients Receiving Hemodialysis: The SONG-HD Fatigue Instrument

BACKGROUND AND OBJECTIVES

Fatigue is a very common and debilitating symptom and identified by patients as a critically important core outcome to be included in all trials involving patients receiving hemodialysis. A valid, standardized measure for fatigue is needed to yield meaningful and relevant evidence about this outcome. This study validated a core patient-reported outcome measure for fatigue in hemodialysis.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

A longitudinal cohort study was conducted to assess the validity and reliability of a new fatigue measure (Standardized Outcomes in Nephrology-Hemodialysis Fatigue [SONG-HD Fatigue]). Eligible and consenting patients completed the measure at three time points: baseline, a week later, and 12 days following the second time point. Cronbach α and intraclass correlation coefficient were calculated to assess internal consistency, and Spearman rho was used to assess convergent validity. Confirmatory factor analysis was also conducted. Hemodialysis units in the United Kingdom, Australia, and Romania participated in this study. Adult patients aged 18 years and over who were English speaking and receiving maintenance hemodialysis were eligible to participate. Standardized Outcomes in Nephrology-Hemodialysis, the Visual Analog Scale for fatigue, the 12-Item Short Form Survey, and Functional Assessment of Chronic Illness Therapy-Fatigue were used.

RESULTS

In total, 485 participants completed the study across the United Kingdom, Australia, and Romania. Psychometric assessment demonstrated that Standardized Outcomes in Nephrology-Hemodialysis is internally consistent (Cronbach α =0.81-0.86) and stable over a 1-week period (intraclass correlation coefficient =0.68-0.74). The measure demonstrated convergence with Functional Assessment of Chronic Illness Therapy-Fatigue and had moderate correlations with other measures that assessed related but not the same concept (the 12-Item Short Form Survey and the Visual Analog Scale). Confirmatory factor analysis supported the one-factor model.

CONCLUSIONS

SONG-HD Fatigue seems to be a reliable and valid measure to be used in trials involving patients receiving hemodialysis.

Fatigue in Peritoneal Dialysis Patients and an Exploration of Contributing Factors: A Cross-Sectional Study

CONTEXT

Fatigue is a common and detrimental symptom in dialysis patients; however, our understanding of it and investigation of its contributing factors is still very limited, especially in peritoneal dialysis (PD) patients.

OBJECTIVES

To assess fatigue in PD patients and identify contributing factors.

METHODS

One hundred eight PD patients in a comprehensive hospital in China were recruited. The fatigue severity of the participants was assessed using the Chalder Fatigue Scale 11. Demographic factors and results of physiological tests were collected. Quality of sleep, mental health, and social support were assessed with the Pittsburgh Sleep Quality Index, Symptom Checklist 90, and Social Support Rating Scale, respectively. Multiple linear regression models were conducted with candidate variables with a P-value of less than 0.1 on univariate analysis and variables that were clinically relevant to identify contributing factors for fatigue.

RESULTS

The fatigue level in PD patients was significantly higher than the community population, and 78.7% of them were suffering from fatigue. The factors that were significantly associated with fatigue were quality of sleep, normalized protein nitrogen appearance, transferrin, alkaline phosphatase, and total cholesterol (adjusted R squared 0.86). Among them, quality of sleep, transferrin, alkaline phosphatase, and total cholesterol were significant contributors for physical fatigue, whereas the quality of sleep and normalized protein nitrogen appearance were contributing factors for mental fatigue.

CONCLUSION

Fatigue is a common symptom in PD patients, suggesting that increased awareness of this symptom is required. The identification of correlates by extensive exploration of multidimensional factors in this study may help practitioners to identify patients at higher risk and to develop a multidimensional and targeted intervention plan.

Health-related quality of life in end-stage renal disease patients, using the Missoula-Vitas quality of life index: a multicenter study

Background and aims

Assessment of Health-related Quality of Life in chronic hemodialysis patients (CHD) is a predictive indicator of the outcome of the disease, including mortality and hospitalization. Regular surveys of the quality of life (QoL) in CHD patients have been conducted worldwide, using various, internationally validated and standardized tools, including the Missoula-VITAS Quality of Life Index scale (MVQOLI). The aim of this study was to examine the reliability and validity of the Bulgarian version of the Missoula-VITAS Quality of Life Index-15 (B-MVQOLI-15) and QoL in CHD patients using this instrument.

Methods

Our study was designed as multi-center cross-sectional. It incorporated 263 end-stage renal disease (ESRD) patients on CHD from across the country and applied the B-MVQOLI-15. Internal consistency and convergent validity of the index were assessed. Non-parametric methods were used to evaluate the impact of demographic factors on the different dimensions scores and on the total score. The relationship between the total QoL score, the total MVQOLI-15 score and dimensions scores were measured based on Spearman's rho Correlation Coefficient.

Results

The total MVQOLI-15 score in the study was 16.44, which is slightly above the middle of the index scale. The patients with higher education were less satisfied with the level of their symptom control compared to patients with lower education. However, high education patients seem to manage better with everyday life compared to those with low education. Men seem to feel more satisfied than women when fulfilling their daily activities (P=0.026). Retired patients and unemployed expressed more satisfaction, compared to the employed (P=0.021). Also, patients on dialysis for over 5 years had lower QoL scores (P=0.043).

Conclusions

B-MVQOLI-15 is a reliable instrument to measure QoL in Bulgarian patients with CHD. The majority of CHD patients rate their QoL as "Fair". Four of all five dimensions positively affect the QoL of CHD patients. The most important dimensions positively affecting the QoL of CHD patients were: interpersonal relationships and transcendent factors. Future studies are necessary to assess the adequacy of the delivered dialysis, the level of medico-social care and the needs of ESRD patients treated with CHD in order to improve their QoL.

A continuous juggle of invisible forces: How fatigued dialysis patients manage daily life

Dialysis patients commonly experience severe fatigue. Fatigue is known as an intrusive symptom strongly affecting perceived quality of life. A total of 23 interviews were conducted to explore how dialysis patients respond to fatigue symptoms and its consequences in daily life. A constructivist grounded theory approach guided data analysis and conceptualization of findings. Patients find themselves within a continuous decision loop, considering ones (physical) abilities and questioning ones normative beliefs and values. This inner process interacts with the outside world, and contains various ambiguities. Improved understanding of this demanding process could help to better address fatigue and positively contribute to the quality of life of dialysis patients.

Implementing an arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis: a feasibility study protocol

BACKGROUND

End-stage kidney disease is a life-changing illness. Many patients require haemodialysis, a treatment that impacts profoundly on quality of life and mental health. Arts-based interventions have been used in other healthcare settings to improve mental health and quality of life; therefore, they may help address the impact of haemodialysis by improving these outcomes. However, there is a lack of evidence assessing their effectiveness in this population and few randomised controlled trials (RCTs) evaluating the effectiveness of complex arts-based interventions.

METHODS

The aims of this study are to establish the feasibility of a cluster RCT of an arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis through a cluster randomised pilot study, explore the acceptability of the intervention with a process evaluation and explore the feasibility of an economic evaluation. The study will have three phases. The first phase consists of a cluster randomised pilot study to establish recruitment, participation and retention rates. This will involve the recruitment of 30 participants who will be randomly allocated through cluster randomisation according to shift pattern to experimental and control group. The second phase will be a qualitative process evaluation to establish the acceptability of the intervention within a clinical setting. This will involve semi-structured interviews with 13 patients and three focus groups with healthcare professionals. The third phase will be a feasibility economic evaluation to establish the best methods for data collection within a future cluster RCT.

DISCUSSION

Arts-based interventions have been shown to improve quality of life in healthcare settings, but there is a lack of evidence evaluating arts-based interventions for patients receiving haemodialysis. This study aims to assess the feasibility of a future cluster RCT assessing the impact of an arts-based intervention on the wellbeing and mental health of patients receiving haemodialysis and identify the key factors leading to successful implementation. The hope is this study will inform a trial that can influence future healthcare policy by providing robust evidence for arts-based interventions within the haemodialysis setting.

TRIAL REGISTRATION

The trial was prospectively registered on clinicaltrials.gov on 14/8/2018, registration number NCT03629496.

An integrative review of the theory of unpleasant symptoms

AIMS

The aim of this study was to explore how the theory of unpleasant symptoms (TOUS) has been used in the methodological design and analysis of symptom research.

DESIGN

An integrative review, using Whittemore and Knafl's approach.

DATA SOURCES

Searches were conducted between 26 January-10 February 2018. Databases included CINAHL Complete, PubMed, Proquest Nursing and Allied Health Source, Health Source: Nursing/Academic Edition, Academic Search Complete and Google Scholar.

REVIEW METHODS

A systematic approach to searching, screening and analysing the literature was applied. The matrix method, content analysis, constant comparison, counting and clustering were used.

RESULTS

Sixty-four records were included. Most studies were quantitative, cross-sectional, instrument-based and conducted in the USA. Various symptoms and patient populations were represented and each of the TOUS concepts were explored.

CONCLUSION

Although the theory has a role to play in furthering symptom science, attention should be paid to the areas of the model and of symptom research that have received less attention. More complex statistical approaches and big data will help to illuminate symptom experiences. Additional focus on intervention studies and all symptom dimensions will help to advance symptom science research.

IMPACT

This review is the first to provide a comprehensive, systematic summary of the uses of the TOUS across the research literature to date. This theory is a diverse, holistic middle-range theory capable of being applied to multiple symptoms and populations. Researchers should consider using the theory as a conceptual framework for studies to advance symptom science and explore symptoms holistically.

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.

Physiological and psychosocial stressors among hemodialysis patients in the Buea Regional Hospital, Cameroon

INTRODUCTION

End Stage Renal Disease (ESRD) is an irreversible kidney condition and hemodialysis is the most frequent treatment option used for this condition. However, hemodialysis also has a detrimental impact on the quality of life and the individuals' physical and psychosocial wellbeing. The main objective of this study was to identify physiological and psychosocial stressors faced by patients undergoing hemodialysis in the Buea Regional Hospital in Cameroon.

METHODS

A cross-sectional study was carried out (December 2016 - January 2017) among patients undergoing hemodialysis at the Buea regional hospital. Data were collected with the use of a structured questionnaire and analyzed using SPSS version 21.0. Quantitative variables were expressed as frequencies, percentages and means.

RESULTS

Among the patients undergoing hemodialysis, 28 (70.0%) were below 5-year dialysis while 12 (30.0%) had been on dialysis for five years and more. 21(52.5%) were male and 19(47.5%) female. Half of the patients were married 20(50%), 13(32.5%) were single, 6(15%) were divorced, and one (2.5%) was a widower. Also, 28 (70.0%) were below 5-year dialysis while 12 (30.0%) had been on dialysis for five years and more. All participants experienced at least one or more physiological and psychosocial stressors. Among physiological stressors, the most frequent were feeling tired (97%), followed by arterial and venous stick (88%) while itching (49.5%) was the least noted physiological stressor. Among psycho-social stressors, the most recurrent were transportation to and from the hospital (99.5%), cost of treatment (99.5%) and Limits on time and place of vacation (99%), followed by Limitation in physical activities, frequent hospitalizations, the length of time on dialysis, uncertainty about the future, changes in life style, increased dependence and sleep disturbances.

CONCLUSION

The topic of stressors is of importance among patients receiving dialysis, as these affect their psycho-social and physiological wellbeing. Thus, nephrologists, nurses and family members play an important role in providing patients with effective psycho-social and physiological support.

Relationship between fatigue symptoms and subjective and objective indicators in hemodialysis patients

PURPOSE

The purpose of the study was to investigate the major factors affecting fatigue symptoms and to examine the relationships between fatigue symptoms and subjective and objective indicators in patients on hemodialysis (HD).

METHODS

Patients on HD who met the inclusion criteria were chosen from two grade A tertiary general hospitals by convenience sampling and cross-sectional survey methods.

RESULTS

A total of 511 patients were included in the study. The morbidity rate of fatigue in patients on HD was 61.6%, and the median fatigue level was 3.91. Fatigue and subjective indicators showed a mild-moderate relationship (0.3 < all |r| < 0.6, all P < 0.001), whereas a weak correlation was found between fatigue and objective indicators (all |r| < 0.2, all P < 0.05). Multivariate analysis showed that subjective indicators, including employment, exercise time, appetite, the vitality of 36-item Short Form Health Survey, perceived social support, intrafamilial support, cramping, headache, chest tightness, and whole-body pain, as well objective indicator, such as serum intact parathyroid hormone levels, were the influence factors of fatigue in patients on HD.

CONCLUSION

The prevalence of fatigue symptoms was high and the level of fatigue was moderate in patients on HD. Subjective and objective indicators can both affect fatigue symptoms in patients on HD.

Fatigue in chronically critically ill patients following intensive care - reliability and validity of the multidimensional fatigue inventory (MFI-20)

Background

Fatigue often occurs as long-term complication in chronically critically ill (CCI) patients after prolonged intensive care treatment. The Multidimensional Fatigue Inventory (MFI-20) has been established as valid instrument to measure fatigue in a wide range of medical illnesses. Regarding the measurement of fatigue in CCI patients, the psychometric properties of the MFI-20 have not been investigated so far. Thus, the present study examines reliability and validity of the MFI-20 in CCI patients.

Methods

A convenience sample of n = 195 patients with Critical Illness Polyneuropathy (CIP) or Myopathy (CIM) were recruited via personal contact within four weeks (t1) following the transfer from acute care ICU to post-acute ICU at a large rehabilitation hospital. N = 113 (median age 61.1 yrs., 72.6% men) patients were again contacted via telephone three (t2) and six (t3) months following the transfer to post-acute ICU. The MFI-20, the Euro-Quality of Life (EQ-5D-3 L) and the Structured Clinical Interview for the Diagnostic and Statistical Manual of mental disorders DSM-IV (SCID-I) were applied within this prospective cohort study.

Results

The internal consistency Cronbach’s α was adequate for the MFI-total and all but the subscale Reduced Motivation (RM) (range: .50–.91). Item-to-total correlations (range: .22–.80) indicated item redundancy for the subscale RM. Confirmatory Factor analyses (CFAs) revealed poor model fit for the original 5-factor model of the MFI-20 (t2/t3, Confirmatory Fit Index, CFI = .783/ .834; Tucker-Lewis Index, TLI = .751/ .809; Root Mean Square Error of Approximation, RMSEA = .112/ .103). Among the alternative models (1-, 2-, 3-factor models), the data best fit to a 3-factor solution summarizing the highly correlated factors General −/ Physical Fatigue/ Reduced Activity (GF/ PF/ RA) (t2/ t3, CFI = .878/ .896, TLI = .846/ .869, RMSEA = .089/ .085, 90% Confidence Interval .073–.104/ .066–.104). The MFI-total score significantly correlated with the health-related quality of life (range: −.65-(−).66) and the diagnosis of major depression (range: .27–.37).

Conclusions

In the present sample of CCI patients, a reliable and valid factor structure of the MFI-20 could not be ascertained. Especially the subscale RM should be revised. Since the factors GF, PF and RA cannot be separated from each other and the unclear factorial structure in the present sample of CCI patients, the MFI-20 is not recommended for use in this context.

Trial registration

German Clinical Trials Registration DRKS00003386. Registered 13 December 2011, retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s12955-018-0862-6) contains supplementary material, which is available to authorized users.

Barriers to exercise for patients with renal disease: an integrative review

Renal disease is a common health condition that leads to loss of physical function, frailty, and premature loss of independence in addition to other severe comorbidities and increased mortality. Increased levels of physical activity and initiation of exercise training is recommended in the current guidelines for all patients with renal disease, but participation and adherence rates are low. The barriers to exercise and physical activity in patients with renal disease are not well defined and currently based on patient provider perception and opinion. There have been no published reviews that have synthesized published findings on patient reported barriers to exercise. This integrative literature review therefore aimed to identify the current understanding of patient reported barriers to regular exercise. This integrative review found that patient perceived barriers to exercise are not consistent with the barriers that have been identified by renal disease specialists and healthcare providers, which were disinterest, lack of motivation, and being incapable of exercise. The patient reported barriers identified through this review were complex and diverse, and the most frequently reported patient perceived barrier to exercise was low energy levels and fatigue. It is clear that additional research to identify patient perceived barriers to exercise is needed and that patient directed interventions to address these barriers should be developed. This integrative review provides information to the interdisciplinary nephrology team that can be used to tailor their assessment of barriers to exercise and provide exercise education for patients with renal disease.

The Relationship Between Fatigue and Depression in Adults With End-Stage Renal Disease on Chronic In-Hospital Hemodialysis: A Scoping Review

CONTEXT

Fatigue and depression are two prominent concerns in patients on in-hospital hemodialysis (IHHD) that have recently been identified as research priorities in the nephrology community. Although they are often reported to co-exist, no synthesis of the literature examining their relationship is available.

OBJECTIVE

The aim of this study was to characterize the literature on the relationship between fatigue and depression in IHHD patients.

METHODS

A scoping review as described by Arksey and O'Malley was conducted. Seven electronic databases were searched for relevant literature using search terms pertaining to fatigue, depression, and IHHD. Key journals and article reference lists were also hand searched to identify relevant literature. Articles were examined for relevance, and data were extracted to describe the nature and scope of the literature and to characterize the relationship between fatigue and depression. Findings were grouped thematically and summarized descriptively.

RESULTS AND CONCLUSIONS

Current literature on this topic is dominated by cross-sectional studies, which support the existence of an association between fatigue and depression in IHHD patients in various practice settings and subpopulations. Numerous multivariable analyses have been performed which suggest the association remains after adjustment for confounding factors. However, there is generally a dearth of longitudinal or interventional literature to clarify the nature of the relationship over time. Current literature is sufficient to justify routine screening for depression in IHHD patients who present with fatigue. Future research should aim to clarify the nature of the relationship over time in IHHD patients, explore mediators and modifiers of the relationship, and investigate the effects of interventions.

The role of psychological factors in fatigue among end-stage kidney disease patients: a critical review

Fatigue is a common and debilitating symptom, affecting 42-89% of end-stage kidney disease patients, persisting even in pre-dialysis care and stable kidney transplantation, with huge repercussions on functioning, quality of life and patient outcomes. This paper presents a critical review of current evidence for the role of psychological factors in renal fatigue. To date, research has concentrated primarily on the contribution of depression, anxiety and subjective sleep quality to the experience of fatigue. These factors display consistent and strong associations with fatigue, above and beyond the role of demographic and clinical factors. Considerably less research is available on other psychological factors, such as social support, stress, self-efficacy, illness and fatigue-specific beliefs and behaviours, and among transplant recipients and patients in pre-dialysis care. Promising evidence is available on the contribution of illness beliefs and behaviours to the experience of fatigue and there is some indication that these factors may vary according to treatment modality, reflecting the differential burdens and coping necessities associated with each treatment modality. However, the use of generic fatigue scales casts doubt on what specifically is being measured among dialysis patients, illness-related fatigue or post-dialysis-specific fatigue. Therefore, it is important to corroborate the available evidence and further explore, qualitatively and quantitatively, the differences in fatigues and fatigue-specific beliefs and behaviours according to renal replacement therapy, to ensure that any model and subsequent intervention is relevant and grounded in the experiences of patients.

Measuring fatigue in haemodialysis patients: The factor structure of the Chalder Fatigue Questionnaire (CFQ)

INTRODUCTION

Fatigue is common in haemodialysis (HD) patients, leading to poorer quality of life and patient outcomes. Given the complex and subjective nature of fatigue, and its overlap with sleep disturbances and depression, its measurement represents a challenge. Our aim was to evaluate the psychometric properties of the 11-item Chalder Fatigue Questionnaire (CFQ) in HD patients, including an assessment of the validity of the factor structure, internal reliability and discriminant validity with respect to functional impairment due to fatigue, psychological distress and comorbidity.

METHODS

Data were evaluated for psychometric analysis from a published study investigating clinical and psychosocial correlates of fatigue among 174 HD patients. Confirmatory factor analysis was used to determine the factor structure using Weighted Least-Squares with Mean and Variance (WLSMV) adjustment estimation. Mplus 7.3 was used for the analysis.

RESULTS

Mental and physical fatigue factors correlated highly (r=.70, p<.01). A bi-factor model with one general fatigue factor, which incorporated three smaller group factors (mental, physical and weakness) had good model fit. The CFQ general factor explained over 85% of the common variance, had high internal consistency, and showed a moderate correlation with distress and a small association with comorbidity and functional impairment.

CONCLUSIONS

The CFQ can be summed up to a total fatigue severity score, representing a composite factor of physical and mental symptoms. Taking into consideration the good psychometric properties of the CFQ and its brief length, it should be used in future studies interested in measuring fatigue severity in HD patients.

Preliminary study of an exercise programme for reducing fatigue and improving sleep among long-term haemodialysis patients

INTRODUCTION

Fatigue and quality of sleep are the main factors that contribute to a poor quality of life among patients on long-term haemodialysis. Studies have also emphasised the importance of exercise for improving the wellbeing of dialysis patients. This study aimed to determine the effectiveness of a predialysis low-to-moderate-intensity exercise programme for reducing fatigue and improving sleep disorders among long-term haemodialysis patients.

METHODS

In this quasi-experimental study, an exercise programme was conducted three times a week for 12 weeks before long-term haemodialysis patients underwent dialysis at two centres. The patients were categorised into either the exercise group (n = 28) or control group (n = 27). The latter was asked to maintain their current lifestyles. Assessments of fatigue and sleep disorder levels were performed for both groups using self-reported questionnaires at baseline and after intervention. The patients' perception of the exercise programme was also determined using self-reported questionnaires.

RESULTS

Paired sample t-test indicated improvements in fatigue level in the exercise group (mean fatigue score: post-treatment 40.5 ± 7.9 vs. pre-treatment 30.0 ± 10.9). Improvements in sleep disorders were also observed in the exercise group (mean score: post-treatment 7.6 ± 3.3 vs. pre-treatment 10.1 ± 3.8). However, sleep quality deteriorated in the control group (mean score: post-treatment 10.7 ± 2.9 vs. pre-treatment 9.3 ± 2.9).

CONCLUSION

Simple low-to-moderate-intensity exercise is effective for improving fatigue, sleep disorders and the overall quality of life among haemodialysis patients.

The Impact of Anxiety and Depression on the Quality of Life of Hemodialysis Patients

Material and Methods:

The sample studied consisted of 395 hemodialysis patients. Data was collected by the completion of a specially designed questionnaire for the needs of the present study which apart from socio-demographic and clinical, it also included HAD_S scale to assess the level of anxiety and depression as well as the scale Missoula-VITAS Quality of Life Index (MVQOLI) to assess patients’ quality of life.

Results:

The results of this study showed that 47.8% had high anxiety levels and 38.2% had high levels of depression. The average total score of quality of life was found to be 17.14. It was also shown that the total score of quality of life presented statistically significant association with family status (p=0.007), educational level (p<0.001), the number of children (p=0.001), patients’ adherence to doctors’ orders (p=0.003) and proposed diet (p=0.002) and the relations of patients with healthcare professionals and the other patients (p<0.001). The multiple linear regression showed that the overall quality of life score was statistically associated with the levels of depression after adjusted for possible confounders. More specifically, it was found that total score of quality of life was 2.5 and 4.4 points lower for patients with moderate and high levels of depression, respectively, compared to patients with low levels of depression (p<0.001).

Conclusions:

Evaluation of anxiety and depression in conjunction with quality of life in hemodialysis patients should be an integral part of the therapeutic regimen.

The impact of depression on fatigue in patients with haemodialysis: a correlational study

AIMS AND OBJECTIVES

To investigate the fatigue levels and important fatigue predictors for patients undergoing haemodialysis.

BACKGROUND

Fatigue is a common symptom for haemodialysis patients. With its debilitating and distressing effects, it impacts patients in terms of their quality of life while also increasing their mortality rate.

DESIGN

A descriptive correlational study.

METHODS

Convenience sampling was conducted at six chosen haemodialysis centres in Southern Taiwan. Data were collected via a structured questionnaire from 193 haemodialysis patients. The scales involved in this study were socio-demographic details, the Center for Epidemiologic Studies Depression Scale, and the Fatigue Scale for haemodialysis patients. Data analysis included percentages, means, standard deviations and hierarchical multiple regression analysis.

RESULTS

The fatigue level for haemodialysis patients was in the moderate range. Results from the hierarchical multiple regression analysis indicated that age, employment status, types of medications, physical activity and depression were significant. Of those variables, depression had the greatest impact on the patients' fatigue level, accounting for up to 30·6% of the explanatory power. The total explanatory power of the regression model was 64·2%.

CONCLUSION

This study determined that for haemodialysis patients, unemployment, increased age, taking more medications or lower exercise frequencies resulted in more severe depression, which translated in turn to higher levels of fatigue. Among all these factors, depression had the greatest impact on the patients' fatigue levels.

RELEVANCE TO CLINICAL PRACTICE

Not only is this finding beneficial to future studies on fatigue as a source of reference, it is also helpful in our understanding of important predictors relating to fatigue in the everyday lives of haemodialysis patients. It is recommended that when caring for fatigued patients, more care should be dedicated to their psychological states, and assistance should be provided in a timely way so as to reduce the amount of fatigue suffered.

Psychometric properties of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) in Chinese patients receiving maintenance dialysis

CONTEXT

Fatigue is a common symptom reported by patients with end-stage renal disease, and it can significantly decrease patients' quality of life. A brief and convenient fatigue assessment tool is needed for Chinese patients on maintenance dialysis.

OBJECTIVES

To determine the psychometric characteristics of the Chinese version of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) in patients receiving maintenance dialysis.

METHODS

The Chinese version of the FACIT-Fatigue was obtained from the FACIT system. Test-retest reliability of this scale was examined using intraclass correlation coefficients, and the internal consistency was calculated by Cronbach's alpha. Content validity was examined using the content validity index (CVI), scale-level CVI/universal agreement, and scale-level CVI/average agreement. Construct validity was tested using Pearson product-moment correlations of the FACIT-Fatigue scores with the Revised Piper Fatigue Scale, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and disease characteristics during the same period.

RESULTS

A total of 172 patients (111 males and 61 females, mean age 52.6 ± 12.5 years) completed this study, with a median FACIT-Fatigue score of 41 (first and third quartiles 34.3-46). The Chinese version of the FACIT-Fatigue had excellent test-retest reliability (intraclass correlation coefficient = 0.98) and internal consistency (Cronbach's alpha = 0.92); the validity of the scale was supported by CVI, scale-level CVI/universal agreement, and scale-level CVI/average agreement values of at 0.67-1, 0.85, and 0.96, respectively. The standard error of measurement of the FACIT-Fatigue was 1.2. The significant correlations between the FACIT-Fatigue score and the Revised Piper Fatigue Scale (r = -0.658), Hospital Anxiety and Depression Scale (-0.566), and Pittsburgh Sleep Quality Index (-0.489) were supported by the FACIT-Fatigue, with good construct validity (all P < 0.01).

CONCLUSION

The FACIT-Fatigue had acceptable validity and reliability for maintenance dialysis patients and can be used as a valid tool for the measurement of fatigue among these Chinese patients.

Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review

CONTEXT

If access to effective palliative care is to extend beyond cancer patients, an understanding of the comparative prevalence of palliative care problems among cancer and non-cancer patients is necessary.

OBJECTIVES

This systematic review aimed to describe and compare the prevalence of seventeen palliative care-related problems across the four palliative care domains among adults with advanced cancer, acquired immune deficiency syndrome, chronic heart failure, end-stage renal disease (ESRD), chronic obstructive pulmonary disease, multiple sclerosis, motor neuron disease, Parkinson's disease, and dementia.

METHODS

Three databases were searched using three groups of keywords. The results of the extraction of the prevalence figures were summarized.

RESULTS

The electronic searches yielded 4697 hits after the removal of 1784 duplicates. Of these hits, 143 met the review criteria. The greatest number of studies were found for advanced cancer (n=57) and ESRD patients (n=47), and 75 of the 143 studies used validated scales. Few data were available for people living with multiple sclerosis (n=2) and motor neuron disease (n=3). The problems with a prevalence of 50% or more found across most of the nine studied diagnostic groups were: pain, fatigue, anorexia, dyspnea, and worry.

CONCLUSION

There are commonalities in the prevalence of problems across cancer and non-cancer patients, highlighting the need for palliative care to be provided irrespective of diagnosis. The methodological heterogeneity across the studies and the lack of non-cancer studies need to be addressed in future research.

A comparison of the discursive practices of perception of patient participation in haemodialysis units

BACKGROUND

According to Norwegian law, nurses are obligated to provide an acceptable level of health assistance to patients and their family members and to allow patients and their family members to participate in the planning of patient care and treatment.

AIM

The aim of this study is to compare the perceptions of older patients undergoing haemodialysis treatment and of their next of kin and of nurses regarding patient participation in the context of haemodialysis treatment.

RESEARCH DESIGN

The study adopts an approach that is both comparative and explorative in nature by examining the narratives of patients, nurses and next of kin and by performing critical discourse analysis as outlined by Fairclough.

ETHICAL CONSIDERATIONS

Permission to carry out the research was granted by the Regional Committee for Medical and Health Research Ethics of Mid-Norway and by the participating hospitals. Informed consent and confidentiality were ensured.

FINDINGS

Two discourses were found: (a) the discourse of paternalism with the discursive practices of achieving physiological balance in patients, trusting the healthcare team and being excluded or included in the difficult end-of-life decision-making process, and (b) the discourse of patient participation, with the themes of maintaining patients' quality of life and trusting patients.

CONCLUSION

The participation of older patients and their next of kin was not as well integrated as social practice in dialysis units. The dominant discourse seemed to have an ideology and social practice of paternalism. However, there existed hegemonic struggles for an ideology of patient participation that involved (a) achieving physiological balance in patients versus maintaining patients' quality of life, (b) trusting the healthcare team versus trusting the patient, and (c) being excluded versus included in the difficult end-of-life decision-making process.

Effect of qigong training on fatigue in haemodialysis patients: A non-randomized controlled trial

BACKGROUND

Fatigue is a debilitating symptom in haemodialysis patients. Qigong presents a potentially safe modality of treatment for chronic fatigue patients but has not yet been evaluated in haemodialysis patients.

OBJECTIVE

The aim of this study is to investigate whether qigong exercise affects fatigue in haemodialysis patients.

DESIGN

A 6-month non-randomized control trial with six measurement periods was conducted. The qigong group was taught to practice qigong three times per week for six months. The control group received usual routine care. Main outcome measure Fatigue, as measured by the "Haemodialysis Patients Fatigue Scale".

RESULTS

A total of 172 patients participated in this study, with 71 patients in the qigong group and 101 patients in the control group. The results indicated that all patients experienced mild to moderate fatigue. There was no difference between the qigong and control groups in fatigue at baseline. However, fatigue was lower in the qigong group than in the control group at 8 weeks (43.5 vs. 53.9), 12 weeks (44.7 vs. 53.6), 16 weeks (43.2 vs. 50.8), 20 weeks (42 vs. 50.2), and 24 weeks (41.4 vs. 48.4). The results, based on the generalized estimating equation method, showed that fatigue was significantly lower in the qigong group than in the control group (odds ratio=0.004, p=0.005).

CONCLUSION

Fatigue in the qigong group showed a continuous decrease, which was maintained until the end of data collection at 24 weeks. Thus, qigong presents a potentially effective and safe method to reduce fatigue in haemodialysis patients.

Different aspects of fatigue experienced by patients receiving maintenance dialysis in hemodialysis units

BACKGROUND

Fatigue, a common symptom reported by patients receiving dialysis, is a multidimensional and subjective experience which is readily understood by individuals but difficult to measure.

OBJECTIVES

This study was performed to identify the prevalence of differential aspects of fatigue among patients receiving maintenance dialysis.

PATIENTS AND METHODS

The cross-sectional study was conducted in two hemodialysis wards in Tehran with a sample of 163 participants. In this study, the multidimensional fatigue inventory was used to determine the level of fatigue. Demographic data were also collected with self-report survey. To analyze data with SPSS statistical software, test Chi square, T-test, and ANOVA were used. P- Value less than 0.05 was considered significant.

RESULTS

All the patients experienced degrees of fatigue and 50 (30.7%) of the participants experienced a high level of fatigue. Fatigue scores arrangement was founded for physical fatigue followed by reduced activity and general fatigue. Lower levels of fatigue were reported for mental fatigue and reduced motivation. There was no diversity in this study in the levels of fatigue in respects of gender and marital status and employment status. Participants with diabetic nephropathy were the most fatigued.

CONCLUSIONS

People with chronic kidney disease regardless of their age, gender, state of health, and duration of hemodialysis experience high levels of fatigue; it is particularly important for health providers to understand this level of fatigue which affects the daily life of patients.

Fatigue in hemodialysis patients: a review of current knowledge

CONTEXT

End-stage renal disease is a common chronic illness increasing in incidence and prevalence. Although kidney function is partially replaced through dialysis, patients endure many symptoms of the disease such as fatigue. Many factors have been studied regarding their relationship with fatigue in this population.

OBJECTIVES

To provide a state of the science review regarding fatigue in hemodialysis patients by examining the experience of fatigue for patients on hemodialysis and correlates of fatigue in patients on hemodialysis.

METHODS

PubMed, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Sociological Abstracts were searched using the key terms "fatigue," "dialysis," and "hemodialysis." Articles written after 1980 and those with explicit findings related to fatigue were included in this review. Articles that discussed fatigue in peritoneal dialysis patients or renal transplant patients were not included.

RESULTS

There is little knowledge regarding the experience of fatigue for patients on hemodialysis and there has been little success identifying demographic, psychosocial, or physiological factors that are consistently related to fatigue.

CONCLUSION

Further work in this area of inquiry would be of benefit and may shed light on the domains of life that are affected by fatigue for hemodialysis patients. It also may help deepen our knowledge regarding correlates that could identify hemodialysis patients who are at increased risk for fatigue.

Exertional fatigue in patients with CKD

BACKGROUND

Fatigue is one of the most prevalent symptoms in chronic kidney disease (CKD). However, fatigue mechanisms are poorly understood due in part to nonspecific definitions. This study investigates exertional fatigue during simulated activities of daily living, focusing on oxygen delivery and utilization.

STUDY DESIGN

"Explanatory" matched-cohort study.

PARTICIPANTS & SETTING

13 patients with CKD (stages 3b-4; mean age, 62 ± 13 [SD] years) and 13 healthy controls, mean matched for age, height, body mass and composition, and physical activity level. Participants completed an incremental cycle ergometer test to simulate energy expenditure of typical activities of daily living.

FACTOR

4 exercise intensities: 1, 1.8, 2.4, and 3.1 metabolic equivalent tasks (METs).

OUTCOMES

The primary outcome was exertional fatigue by rating of perceived exertion (RPE) on a 6-20 scale.

MEASUREMENTS

Other multidimensional measures of fatigue: UK Short Form Health Survey 36 (UK SF-36) Vitality and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) subscales. Physiologic measures of the oxygen transport and utilization chain (expired gas analysis, cardiac output, and arterial oxygen content) and blood lactate.

RESULTS

RPE was increased in patients compared with controls at 2.4 (10.5 [ie, light] ± 2.7 vs 8.7 [very light] ± 1.7 units) and 3.1 (12.5 [somewhat hard] ± 2.6 vs 10.2 [light] ± 1.7 units) METs (interaction P = 0.03), which was consistent with higher chronic fatigue in patients by both the UK SF-36 Vitality (P = 0.01) and FACIT-Fatigue (P = 0.004) subscales. Arterial oxygen content was decreased in patients (P = 0.001), but cardiac output and oxygen extraction ratio were unchanged, decreasing oxygen delivery (P = 0.04). Respiratory exchange ratio (P = 0.004) and blood lactate production (P = 0.002) were increased.

LIMITATIONS

Those inherent to a matched-cohort study.

CONCLUSIONS

Using a novel application of the outcome measure RPE, patients with non-dialysis-dependent CKD reported considerable exertional fatigue during simulated activities of daily living. Poor compensation for mild anemia contributed to this symptom. In addition to anemia, the entire oxygen transport chain needs to be targeted to treat fatigue in patients with CKD.

Nurses’ perceptions of patient participation in hemodialysis treatment

The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses’ power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions.