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

Navigating strategies used to manage fatigue by patients undergoing hemodialysis: a qualitative exploratory design

BACKGROUND

Fatigue among patients with end-stage kidney disease (ESKD) undergoing hemodialysis significantly impacts quality of life and anticipated treatment results. This study explores how Omani patients undergoing hemodialysis manage their fatigue.

METHODS

A qualitative design was employed. Data were collected from 25 participants through semi-structured interviews, which were transcribed verbatim and analyzed using thematic analysis. Data management, memo creation, and annotation were completed using NVivo 11.

RESULTS

Findings highlighted one main overarching theme, Self-initiated management strategies, outlining the coping mechanisms patients used to reduce fatigue and adapt their daily activities to its ongoing presence. This overarching theme encapsulates six subthemes that describe patients' self-initiated strategies to manage fatigue, which include (1) self-regulating weight gain and negotiating accumulated fluid removal with healthcare providers (HCPs); (2) Increased appetite and desire for rest; (3) expanding self-awareness for change; (4) engaging in regular physical activity; (5) seeking deeper understanding and support from others and (6) immersing in faith and religious practices.

CONCLUSIONS

The study findings emphasize that patients used several management strategies to manage both physical and mental fatigue and improve their quality of daily living. Although these techniques used to manage fatigue by patients were helpful, healthcare professionals must provide a holistic approach to support the patient's self-initiated fatigue management strategies. Therefore, further studies would be required both within nationally and internationally to validate study findings, and find methods to promote the positive coping techniques used.

CLINICAL TRIAL NUMBER

Not applicable.

Insights into the complexities of symptom management for hemodialysis patients: a systematic review of qualitative studies

Patients undergoing hemodialysis experience a broad spectrum of symptoms that impact their physical, psychological, and social well-being. Traditional qualitative studies often focus on isolated aspects of patient experiences and offer limited insights into the interconnected nature of symptom management. This systematic review and meta-ethnography aims to synthesise qualitative studies and develop a comprehensive model that elucidates interrelations between patient experiences and symptom management practices in hemodialysis. Our analysis integrated findings from 30 qualitative studies using a meta-ethnographic approach. The results revealed critical psychological and social dynamics influencing symptom management. The model highlights how supportive factors, such as family involvement and effective healthcare interactions, enhance coping mechanisms, improving emotional resilience and treatment adherence. Conversely, it identifies significant barriers, including chronic self-regulatory burnout and systemic inefficiencies, that hinder symptom management and exacerbate psychological distress. By integrating diverse qualitative findings, this study proposes a shift towards patient-centred, culturally sensitive care strategies that prioritise psychological support. This shift aims to transform hemodialysis care by addressing the complex interplay of medical, psychological, and social factors. The developed framework not only facilitates deeper understanding of the psychological impacts of symptom management and offers a structured approach for future research and interventions in this domain[Q1].

Impact of variables on recovery time in patients undergoing hemodialysis: an international survey

BACKGROUND

Dialysis recovery time (DRT) refers to the period during which fatigue and weakness subside following hemodialysis treatment, allowing patients to resume their daily routines. This study aimed to identify the factors influencing DRT in hemodialysis patients in Turkey and Portugal, where the prevalence of chronic kidney disease is notably high.

METHODS

A cross-sectional observational study was conducted in a private dialysis center in Turkey and three dialysis centers in Portugal. The study included hemodialysis patients aged 18 years or older who had been undergoing four-hour hemodialysis sessions three times a week for at least six months. Participants had no communication barriers and voluntarily agreed to take part in the study. Data were collected using a semi-structured questionnaire to gather descriptive characteristics and the Hospital Anxiety and Depression Scale. Logistic regression analysis was employed to identify independent variables influencing DRT.

RESULTS

A total of 294 patients participated in the study, including 187 from Turkey and 107 from Portugal. In Turkey, increased interdialytic weight gain (P = 0.043) was associated with prolonged recovery time, while the use of high-flux dialyzers (P = 0.026) was linked to shorter recovery times. In Portugal, older age (P = 0.020) was found to extend recovery time.

CONCLUSION

Recovery time after dialysis is influenced by varying factors across different countries. Further research with larger sample sizes is needed to deepen understanding of these factors and their implications.

CLINICAL TRIAL NUMBER

NCT04667741.

The lived experiences of fatigue among patients receiving haemodialysis in Oman: a qualitative exploration

BACKGROUND

Fatigue among patients with end-stage kidney disease (ESKD) receiving haemodialysis imposes a substantial burden on patients' quality of life and expected treatment outcomes. This study explores the perspective on ESKD-related fatigue and contributing factors among Omani patients receiving haemodialysis.

METHODS

An exploratory qualitative design was used. Participants (N = 25) were recruited from two Omani haemodialysis centres, and data were collected through semi-structured interviews, which were transcribed and analysed using a thematic analysis approach. NVivo 11 is used to manage qualitative data and create memos, nodes, and codes.

RESULTS

Findings highlighted three themes: (i)"Inevitability of fatigue," (ii)"Contributors to physical fatigue," and (iii)"Contributors to mental fatigue." Theme one alluded to the inevitability of fatigue and the unique experience encountered by patients. Theme two addressed the physical fatigue associated with ESKD-related factors, such as chronically low haemoglobin levels, and the exhausting impact caused by the frequency and travelling distance for treatment sessions. Theme three, mental fatigue, was notably driven by heightened emotional disturbance, encompassing frustration, guilt, anxiety, and distress, that in turn impacted family interactions, frequently triggering anger and remorse. Moreover, mental fatigue is a result of disturbances in expressing physical sexuality in marriage, as physical fatigue was found to be a significant contributor to unsatisfactory sexual experiences and, thus, straining the relationships between couples.

CONCLUSIONS

This study offers an explanation of fatigue among Omani patients with ESKD who are receiving haemodialysis. The study emphasises close links between physiological change, the haemodialysis process, and mental tiredness, together with their contribution to supporting the need for a holistic approach and care strategies in managing these patients and promoting patient and family well-being.

Prevention and management of foot and lower limb health complications in adults undergoing dialysis: a scoping review

BACKGROUND

Foot and lower limb health complications are common among patients undergoing dialysis; but a summary of prevention and management evidence is not available. The aim of this scoping review was to summarise study characteristics and the nature of results regarding strategies to prevent and manage peripheral arterial disease (PAD), foot ulceration, amputation, associated infection and associated hospital admission in adults undergoing dialysis.

METHODS

MEDLINE, Embase, CINAHL and AMED databases were searched for longitudinal experimental and observational studies. Eligible studies included adults undergoing dialysis (≥10 dialysis patients, with separate results or ≥ 75% of the cohort). Any interventions relating to PAD, foot ulceration, amputation, associated infection, and associated hospital admission were included.

RESULTS

The review included 212 studies, of which 199 were observational (94%) and 13 were experimental (6%). Sixteen studies (8%) addressed the prevention of foot and lower limb health complications, 43 (20%) addressed management, and 153 (72%) addressed both. The main intervention type in each study was surgery (n = 159, 75%), care from one or more health professionals (n = 13, 6%), screening by a health professional (n = 10, 5%), medication (n = 9, 4%) and rehabilitation (n = 5, 2%). No studies were identified where exercise, offloading or education were the main intervention. Results for PAD were reported in 137 (65%) studies, foot ulceration in 54 (25%), amputation in 171 (81%), infection in 7 (3%), and admission in 26 studies (12%). Results for more than one foot or lower limb outcome were reported in 141 studies (67%), with each study reporting on average two outcomes. Results varied and spanned positive, negative, and neutral outcomes following intervention.

CONCLUSIONS

Identified studies frequently aimed to both prevent and manage foot and lower limb health complications. A variety of interventions were identified and studies often reported results for more than one foot or lower limb health outcome. Findings from this review can be used to guide future research, with a goal to support improved patient outcomes.

Prevalence and influencing factors of fatigue among patients undergoing continuous ambulatory peritoneal dialysis: A cross-sectional study

Background

Fatigue is one of the most commonly reported symptoms among patients undergoing continuous ambulatory peritoneal dialysis (CAPD). However, only a few studies have addressed the prevalence of fatigue and its influencing factors within this population in Thailand.

Objective

This study aimed to explore the prevalence of fatigue and its influencing factors, including duration of CAPD initiation, body mass index, insomnia, social support, functional status, and depression among patients undergoing CAPD.

Methods

This cross-sectional study involved 136 participants from the outpatient department of a general hospital in Thailand. Data were collected from January to March 2023, utilizing validated self-reported questionnaires, which included the Center for Epidemiologic Study Depression Scale, Insomnia Severity Index, Multidimensional Scale of Perceived Social Support, Functional Status Scale, and Fatigue Severity Scale. Data were analyzed using descriptive statistics, Pearson's product-moment correlation, and Stepwise multiple regressions.

Results

The study achieved a 100% participation rate among the selected participants. The prevalence of fatigue among patients undergoing CAPD was 55.88%, including mild fatigue (20.59%), moderate fatigue (19.85%), and severe fatigue (15.44%). Bivariate analysis indicated that fatigue-related factors were insomnia, depression, body mass index, social support, and functional status. However, the multiple regression analysis revealed that only insomnia (β = 0.399, p <0.001), social support (β = -0.302, p <0.001), depression (β = 0.201, p = 0.003), and functional status (β = -0.149, p = 0.021) jointly influenced fatigue among patients undergoing CAPD, explaining 50.10 percent of the variance (R2 = 0.501, F(4, 131) = 32.871, p <0.001).

Conclusion

The findings indicated that more than half of the participants experienced fatigue. Insomnia, social support, depression, and functional status emerged as significant predictive factors of fatigue. Therefore, it is advisable for nurses and other healthcare providers to evaluate fatigue and its associated factors routinely. Nursing interventions to alleviate fatigue should prioritize improvements in sleep quality, reduction of depression, preservation of functional status, and promotion of family engagement.

Psychometric Properties of the Brief Fatigue Inventory in Hemodialysis Patients during a Dialysis Day: A Preliminary Report

The aim of this study was to evaluate the psychometric properties of the Brief Fatigue Inventory (BFI) in hemodialysis patients. During a dialysis day, patients completed both 9-item BFI and 21-item Beck Depression Inventory (BDI)-II questionnaires. The psychometric properties of the BFI were assessed in terms of reliability and validity. The BFI had an overall Cronbach's coefficient alpha of .92. Inter-item correlation coefficients between BFI items ranged from .38 to. 81 (all p < .0001). Exploratory factor analysis revealed bidimensional factor structure of the BFI-fatigue "severity" and fatigue "interference" explaining 11.0% and 62.0% of the total variance in the data set, respectively. In criterion validity analysis, BFI composite score correlated significantly with the total BDI-II score-Pearson correlation coefficient .40 (p < .0001). These preliminary results support the satisfactory psychometric properties of the BFI in assessing fatigue among hemodialysis patients during a dialysis day in a clinic setting.

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.

The impact of transvenous cardioverter-defibrillator implantation on quality of life, depression and optimism in dialysis patients: report on the secondary outcome of QOL in the randomized controlled ICD2 trial

RATIONALE

The impact of prophylactic implantable cardioverter-defibrillator (ICD) implantation on the psychological well-being of patients on dialysis is unknown.

OBJECTIVE

We aimed to identify the effect of primary ICD implantation on quality of life (QoL), mood and dispositional optimism in patients undergoing dialysis.

METHODS AND RESULTS

We performed a prespecified subanalysis of the randomized controlled ICD2 trial. In total, 177 patients on chronic dialysis, with an age of 55-81 years, and a left ventricular ejection fraction of ≥ 35%, were included in the per-protocol analysis. Eighty patients received an ICD for primary prevention, and 91 patients received standard care. The Short Form-36 (SF-36), Geriatric Depression Scale-15 (GDS-15), Revised Life Orientation Test (LOT-R) questionnaires were administered prior to ICD implantation (T0), and at 1-year follow-up (T1) to assess QoL, depression and optimism, respectively. The patients were predominantly male (76.0%), with a median age of 67 years. Hemodialysis was the predominant mode of dialysis (70.2%). The GDS-15 score difference (T1 - T0) was 0.5 (2.1) in the ICD group compared with 0.3 (2.2) in the control group (mean difference - 0.3; 95% CI - 1.1 to 0.6; P = 0.58). The LOT-R score difference was - 0.2 (4.1) in the ICD group compared with - 1.5 (4.0) in the control group (mean difference - 1.1 (0.8); 95% CI - 2.6 to 0.4; P = 0.17). The mean difference scores of all subscales of the SF-36 were not significantly different between randomization groups.

CONCLUSIONS

In our population of patients on dialysis, ICD implantation did not affect QoL, mood or dispositional optimism significantly during 1-year follow-up.

CLINICAL TRIAL REGISTRATION

Unique identifier: ISRCTN20479861. http://www.controlled-trials.com .

Physical activity and posttraumatic growth in patients receiving maintenance hemodialysis: A prospective study

This study used a prospective design to examine the association between self-reported physical activity and posttraumatic growth (PTG) over a 1-year period among 150 patients receiving maintenance hemodialysis. Transport-related, household, and leisure-time physical activity were positively associated with PTG at baseline and follow-up. Total physical activity could predict higher levels of PTG at follow-up, after controlling for baseline PTG and other covariates. The findings indicate that daily physical activity could be a modifiable behavioral factor associated with PTG among patients receiving maintenance hemodialysis. Further study is needed using a randomized controlled design and objective measures of physical activity.