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Sands I, Picariello F, Maple H, Chilcot J. Psychosocial and Clinical Associations of Fatigue Severity and Fatigue-Related Impairment in Kidney Transplant Recipients. Behav Med 2024; 50:153-163. [PMID: 36803685 DOI: 10.1080/08964289.2022.2159311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 02/22/2023]
Abstract
Debilitating fatigue is common in people living with kidney disease and often persists after a kidney transplant. Current understanding of fatigue is centered around pathophysiological processes. Little is known about the role of cognitive and behavioral factors. The aim of this study was to evaluate the contribution of these factors to fatigue among kidney transplant recipients (KTRs). A cross-sectional study of 174 adult KTRs who completed online measures of fatigue, distress, illness perceptions, and cognitive and behavioral responses to fatigue. Sociodemographic and illness-related information was also collected. 63.2% of KTRs experienced clinically significant fatigue. Sociodemographic and clinical factors explained 16.1% and 31.2% of the variance in the fatigue severity and fatigue impairment, respectively, increasing by 28% and 26.8% after adding distress. In adjusted models, all the cognitive and behavioral factors except for illness perceptions were positively associated with increased fatigue-related impairment, but not severity. Embarrassment avoidance emerged as a key cognition. In conclusion, fatigue is common following kidney transplantation and associated with distress and cognitive and behavioral responses to symptoms, particularly embarrassment avoidance. Given the commonality and impact of fatigue in KTRs, treatment is a clinical need. Psychological interventions targeting distress and specific beliefs and behaviors related to fatigue may be beneficial.
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Affiliation(s)
- Imogen Sands
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hannah Maple
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Huang LT, Zheng XY, Zhang ZH, Zheng HY, Wei X, Yang JY, Zhang LH, Lu XQ, Yang YQ, Lin JX, Zhang CM, Luo LP, Jiang DH, Huang SH, Huang XB, Zhan YM, Xu WZ, Han W, Hong FY. Translation, cultural adaptation, and validation of the Chinese standardized outcomes in nephrology-hemodialysis fatigue (C-SONG-HD fatigue) scale: a study of Chinese patients undergoing hemodialysis. Qual Life Res 2024; 33:745-752. [PMID: 38064016 DOI: 10.1007/s11136-023-03561-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2023] [Indexed: 02/26/2024]
Abstract
OBJECTIVE This study aimed to translate and culturally adapt the standardized outcomes in nephrology-hemodialysis fatigue (SONG-HD fatigue) scale and to assess the psychometric properties of the Chinese version of the SONG-HD fatigue (C-SONG-HD fatigue) scale. METHODS Forward and back translations were used to translate the SONG-HD fatigue scale into Chinese. We used the C-SONG-HD fatigue scale to survey Chinese patients undergoing hemodialysis (HD) in China. We examined the distribution of responses and floor and ceiling effects. Cronbach's alpha and McDonald's omega coefficient, intraclass coefficients, and Spearman correlations were used to assess internal consistency reliability, test-retest reliability, and convergent validity, respectively. Responsiveness was also evaluated. RESULTS In total, 489 participants across southeast China, northwest China, and central China completed the study. The C-SONG-HD fatigue scale had good internal consistency (Cronbach's alpha coefficient 0.861, omega coefficient 0.916), test-retest reliability (intraclass correlation coefficient 0.695), and convergent validity (Spearman correlation 0.691). The analysis of all first-time HD patients did not show notable responsiveness, and only patients with temporary vascular access had good responsiveness with an effect size (ES) of 0.54, a standardized response mean (SRM) of 0.85, and a standard error of measurement (SEM) of 0.77. CONCLUSION The Chinese version of the SONG-HD fatigue scale showed satisfactory reliability and validity in patients undergoing hemodialysis (HD) in China. It could be used as a tool to measure the fatigue of Chinese HD patients.
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Affiliation(s)
- Lan-Ting Huang
- Department of Nephrology, Fujian Provincial Hospital and Fujian Medical University, Fuzhou, Fujian, China.
| | - Xiao-Yan Zheng
- Department of Blood Purification, Fujian Provincial Hospital and Fujian Medical University, Fuzhou, Fujian, China
| | - Zhi-Hong Zhang
- Department of Blood Purification, Fujian Provincial Hospital and Fujian Medical University, Fuzhou, Fujian, China
| | - Hong-Yan Zheng
- Department of Blood Purification, Renhe Hospital of Hubei Three Gorges University, Yichang, Hubei, China
| | - Xin Wei
- Department of Blood Purification, Xinjiang Changji Hui Autonomous Prefecture Hospital of Traditional Chinese Medicine, Changji, Xinjiang, China
| | - Ji-Yan Yang
- Department of Blood Purification, Pengyang People's Hospital of Ningxia Hui Autonomous Region, Pengyang, Ningxia, China
| | - Li-Hua Zhang
- Department of Blood Purification, Fuzhou First Hospital, Fuzhou, Fujian, China
| | - Xiu-Qin Lu
- Department of Blood Purification, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Ying-Qing Yang
- Department of Blood Purification, Affiliated Hospital of Putian University, Putian, Fujian, China
| | - Jin-Xia Lin
- Department of Blood Purification, Quanzhou First Hospital, Quanzhou, Fujian, China
| | - Chun-Mei Zhang
- Department of Blood Purification, Wuyishan Municipal Hospital, Wuyishan, Fujian, China
| | - Li-Ping Luo
- Department of Blood Purification, Nanping People's Hospital, Nanping, Fujian, China
| | - Dong-Hua Jiang
- Department of Blood Purification, Sanming Second Hospital, Sanming, Fujian, China
| | - Shao-Hua Huang
- Department of Blood Purification, Sanming First Hospital, Sanming, Fujian, China
| | - Xiu-Bi Huang
- Department of Blood Purification, Zhangzhou Hospital, Zhangzhou, Fujian, China
| | - Yue-Mei Zhan
- Department of Blood Purification, Longyan First Hospital, Longyan, Fujian, China
| | - Wen-Zhu Xu
- Department of Blood Purification, Ningde Mindong Hospital, Mindong, Fujian, China
| | - Wei Han
- Department of Blood Purification, Xiamen Zhongshan Hospital, Xiameng, Fujian, China
| | - Fu-Yuan Hong
- Department of Nephrology, Fujian Provincial Hospital and Fujian Medical University, Fuzhou, Fujian, China.
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Zakrzewska A, Biedunkiewicz J, Komorniczak M, Jankowska M, Jasiulewicz K, Płonka N, Biedunkiewicz B, Małgorzewicz S, Tarasewicz A, Puchalska-Reglińska E, Siebert J, Dębska-Ślizień A, Tylicki L. Intradialytic Tolerance and Recovery Time in Different High-Efficiency Hemodialysis Modalities. J Clin Med 2024; 13:326. [PMID: 38256460 PMCID: PMC10816973 DOI: 10.3390/jcm13020326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
There are several forms of maintenance high-efficiency hemodialysis (HD), including hemodiafiltrations (HDF) in different technical modes and expanded HD, using dialyzers with medium cut-off membranes. The aim of the study was to assess the intradialytic tolerance and length of dialysis recovery time (DRT) in these modalities. This is an exploratory, crossover study in maintenance HD patients with low comorbidity and no clinical indications for the use of high-efficiency HD, who were exposed to five intermittent dialyses in random order: high-flux hemodialysis (S-HD), expanded HD (HDx), pre-dilution HDF (PRE-HDF), mix-dilution HDF (MIX-HDF) and post-dilution HDF (POST-HDF). Twenty-four dialysis sessions of each method were included in the analysis. Dialysis parameters, including blood flow rate, dialysis fluid flow rate and temperature, and pharmacological treatment were constant. Average total convection volume for post-HDF, pre-HDF and mix-HDF were 25.6 (3.8), 61.5 (7.2) and 47.1 (11.4) L, respectively. During all therapies, patients were monitored for the similarity of their hydration statuses using bioimpedance spectroscopy, and for similar variability over time in systemic blood pressure and cardiac output, while peripheral resistance was monitored using impedance cardiography. The lowest frequency of all intradialytic adverse events were observed during HDx. Delayed DRT was the shortest during PRE-HDF. Patients were also more likely to report immediate recovery while receiving PRE-HDF. These differences did not reach statistical significance; however, the study results suggest that intradialytic tolerance and DRT may depend on the dialysis method used. This supports the need of taking into account patient preferences and quality of life while individualizing high-efficiency therapy in HD patients.
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Affiliation(s)
- Agnieszka Zakrzewska
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland (M.K.); (M.J.); (K.J.); (B.B.)
| | - Jan Biedunkiewicz
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, 80-214 Gdańsk, Poland;
| | - Michał Komorniczak
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland (M.K.); (M.J.); (K.J.); (B.B.)
| | - Magdalena Jankowska
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland (M.K.); (M.J.); (K.J.); (B.B.)
| | - Katarzyna Jasiulewicz
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland (M.K.); (M.J.); (K.J.); (B.B.)
| | - Natalia Płonka
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland (M.K.); (M.J.); (K.J.); (B.B.)
| | - Bogdan Biedunkiewicz
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland (M.K.); (M.J.); (K.J.); (B.B.)
| | - Sylwia Małgorzewicz
- Department of Clinical Nutrition, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Agnieszka Tarasewicz
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland (M.K.); (M.J.); (K.J.); (B.B.)
| | | | - Janusz Siebert
- Department of Family Medicine, University Center for Cardiology, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland (M.K.); (M.J.); (K.J.); (B.B.)
| | - Leszek Tylicki
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland (M.K.); (M.J.); (K.J.); (B.B.)
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Ouyang Q, Yang F, Wu H, Tang S, Peng X, Li Y, Wang J. The Effects of Dialysis Modality and Emotional Distress on Fatigue in Patients Undergoing Dialysis. Blood Purif 2023; 52:751-758. [PMID: 37703855 DOI: 10.1159/000532058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/13/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Fatigue is a common but often overlooked symptom in dialysis patients. Factors affecting fatigue in dialysis patients are currently unclear. There are few studies on the effects of mental factors and dialysis modality on fatigue. This study aims to explore the potential relationship between fatigue and insomnia, as well as psychiatric disorders such as anxiety and depression among patients who undergo peritoneal dialysis (PD) or hemodialysis (HD). METHODS There were 96 HD patients and 160 PD patients at our hospital who voluntarily participated in the survey. A questionnaire survey was conducted to gather general characteristics of the patients and to evaluate fatigue, sleep quality, anxiety, and depression levels among PD and HD patients. RESULTS The overall fatigue score was 53.83 ± 14.22 for the PD group and 57.92 ± 16.35 for the HD group. Notably, the fatigue level was lower in the PD group compared to the HD group (p < 0.05). Univariate analysis indicated that fatigue was associated with occupational status and income in the PD group, as well as educational level and income in the HD group (p < 0.05). Correlation analysis revealed that patients in both groups who were older and had higher scores for insomnia, anxiety, and depression experienced more severe fatigue. Moreover, body mass index was positively correlated with fatigue status in the PD group, while duration of dialysis showed a positive association with fatigue in the HD group. Multivariate regression analysis identified income and depression as major factors influencing fatigue in the PD group, and duration of dialysis, income, and depression in the HD group. CONCLUSION Patients who undergo dialysis exhibit high levels of fatigue, with the severity of fatigue being less pronounced in the PD group compared to the HD group. Fatigue in these patients is associated with the duration of dialysis, income level, and presence of depression.
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Affiliation(s)
- Qin Ouyang
- Department of Nephropathy, Third Xiangya Hospital of Central South University, Changsha, China
| | - Fengjie Yang
- Department of Pediatrics, Third Xiangya Hospital of Central South University, Changsha, China
| | - Hong Wu
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Shiqi Tang
- Department of Nephropathy, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xinyue Peng
- Department of Nephropathy, Third Xiangya Hospital of Central South University, Changsha, China
| | - Yuxin Li
- Department of Nephropathy, Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianwen Wang
- Department of Nephropathy, Third Xiangya Hospital of Central South University, Changsha, China
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Worsley ML, Pai A, Gregg LP. Measurement of Fatigue in Patients Receiving Kidney Replacement Therapy. Am J Kidney Dis 2023; 82:7-10. [PMID: 37178092 PMCID: PMC11078093 DOI: 10.1053/j.ajkd.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/08/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Melandrea L Worsley
- Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
| | - Akshta Pai
- Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas; Renal Section, Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - L Parker Gregg
- Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas; Research Service Line, Michael E. DeBakey VA Medical Center, Houston, Texas; Veterans Affairs Health Services Research & Development Center for Innovation in Quality, Effectiveness and Safety, Houston, Texas.
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Xiao P, Wang ZH, Lu Y, Zhang S, Jin YX, Liu X, Jiang ZL, Liu SX. Association between corrected serum calcium levels after dialysis and post-dialysis fatigue risk: a hospital-based case-control study. Eur J Med Res 2023; 28:173. [PMID: 37183248 PMCID: PMC10184336 DOI: 10.1186/s40001-023-01131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE Post-dialysis fatigue (PDF) is an important problem in patients undergoing maintenance hemodialysis (MHD); however, evidence of the association between serum calcium after dialysis and the risk of PDF is limited and controversial. We explored this association among patients receiving MHD. METHODS We carried out a case-control study of patients in the dialysis unit of Dalian Municipal Central Hospital between December 2019 and January 2020, including 340 patients with PDF and 270 patients without PDF. PDF was assessed by a \validated self-administered questionnaire. Clinical variables were tested for multicollinearity using variance inflation factor analysis. Corrected serum calcium levels were categorized into three groups, with the lowest tertile used as the reference category. The odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for PDF risk were estimated using an unconditional logistic regression model. RESULT After adjusting for potential confounders, corrected serum calcium levels showed a significant positive association with the risk of PDF (ORT3vs.T1 = 1.61, 95% CI = 1.01-2.58). Notably, after stratification by age, corrected serum calcium was also positively associated with the risk of PDF in patients aged ≥ 65 years (ORT3vs.T1 = 4.25, 95% CI 1.66-11.46). Furthermore, a significant linear trend and interaction were also observed (P < 0.05). DISCUSSION Higher corrected serum calcium levels after dialysis might increase the risk of PDF among MHD patients. However, further studies are warranted to confirm these findings.
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Affiliation(s)
- Ping Xiao
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Zhi-Hong Wang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Yan Lu
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Shuang Zhang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Yu-Xin Jin
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Xin Liu
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Zhen-Li Jiang
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China
| | - Shu-Xin Liu
- Department of Nephrology, Dalian Municipal Central Hospital, No.826, Xinan Road, Dalian, 116033, Liaoning, People's Republic of China.
- Key Laboratory of Intelligent Blood Purification, Dalian City. Dalian Municipal Central Hospital, Dalian, China.
- Department of Nephrology, Dalian Municipal Central Hospital affiliated with Dalian University of Technology, Dalian, China.
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Katayama Y, Miyawaki Y, Shidahara K, Nawachi S, Asano Y, Ohashi K, Katsuyama E, Katsuyama T, Narazaki M, Matsumoto Y, Sada KE, Yajima N, Shimojima Y, Yoshimi R, Ichinose K, Kajiyama H, Fujiwara M, Sato S, Wada J. Association of alcohol consumption and fatigue in SLE: A cross-sectional study from Lupus Registry of Nationwide Institution (LUNA) cohort. Lupus 2023; 32:531-537. [PMID: 36800905 DOI: 10.1177/09612033231159471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Fatigue is one of the most common complaints and is a potentially modifiable issue in systemic lupus erythematosus (SLE). Studies suggest that alcohol consumption has a protective effect against the development of SLE; however, an association between alcohol consumption and fatigue in patients with SLE has not been studied. Here, we assessed whether alcohol consumption was associated with fatigue using lupus patient-reported outcomes (LupusPRO). METHODS This cross-sectional study, conducted between 2018 and 2019, included 534 patients (median age, 45 years; 87.3% female) from 10 institutions in Japan. The main exposure was alcohol consumption, which was defined as the frequency of drinking [<1 day/month (none group), ≤1 day/week (moderate group), and ≥2 days/week (frequent group)]. The outcome measure was the Pain Vitality domain score in LupusPRO. Multiple regression analysis was performed as the primary analysis after adjusting for confounding factors, such as age, sex, and damage. Subsequently, the same analysis was performed as a sensitivity analysis after multiple imputations (MIs) for missing data (n = 580). RESULTS In total, 326 (61.0%) patients were categorized into the none group, 121 (22.7%) into the moderate group, and 87 (16.3%) into the frequent group. The frequent group was independently associated with less fatigue compared with none group [β = 5.98 (95% CI 0.19-11.76), p = 0.04], and the results did not substantially deviate after MI. CONCLUSIONS Frequent drinking was associated with less fatigue, which highlights the need for further longitudinal studies focusing on drinking habits in patients with SLE.
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Affiliation(s)
- Yu Katayama
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshia Miyawaki
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kenta Shidahara
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shoichi Nawachi
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Asano
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keiji Ohashi
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Eri Katsuyama
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Katsuyama
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mariko Narazaki
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshinori Matsumoto
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Kochi, India
| | - Nobuyuki Yajima
- Division of Rheumatology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan.,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, 26438Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Kajiyama
- Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Michio Fujiwara
- Department of Rheumatology, 84178Yokohama Rosai Hospital, Yokohama, Japan
| | - Shuzo Sato
- Department of Rheumatology, 183174Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology, and Metabolism, 199491Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Al-hakeim HK, Twaij BAA, Ahmed MH, Almulla AF, Moustafa SR, Maes M. In end-stage kidney disease, inflammation, erythron abnormalities and declined kidney function tests are accompanied by increased affective symptoms, chronic-fatigue, and fibromyalgia.. [DOI: 10.1101/2023.01.12.23284460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
AbstractBackgroundNumerous neuropsychiatric symptoms, including affective symptoms, chronic fatigue syndrome, and fibromyalgia symptoms, are present in patients with end-stage renal disease (ESRD). This study examines the relationship between neuropsychiatric symptoms and red blood cell (RBC) parameters, kidney function tests, zinc, C-reactive protein, and calcium levels in patients with ESRD.MethodsThe above biomarkers and the Beck-Depression Inventory, the Hamilton Anxiety Rating Scale, and the Fibro-Fatigue Rating Scale were measured in 70 patients with end-stage renal disease (ESRD) and 46 healthy controls.ResultsIncreased scores of depressive, anxious, cognitive, and physiosomatic symptoms (including chronic fatigue, fibromyalgia, and autonomous symptoms) characterise ESRD. One latent vector could be extracted from these diverse symptom domains, which are, therefore, manifestations of a common core referred to as the physio-affective phenome. The combined effects of aberrations in red blood cells (RBC) (number of RBC, hematocrit, and haemoglobin), kidney function tests (glomerular filtration rate, ureum, creatinine, albumin, and total serum protein), C-reactive protein, zinc, and copper explained 85.0% of the variance in the physio-affective phenome. In addition, the effects of kidney function decline on the phenome were partially mediated by RBC aberrations and elevated copper, whereas the effects of dialysis frequency were entirely mediated by decreased zinc and elevated CRP.ConclusionsAffective (depression and anxiety), cognitive, and physiosomatic symptoms due to ESRD are interrelated manifestations of the physio-affective phenome, which is driven by (in descending order of importance) kidney dysfunctions, erythron deficits, inflammation, elevated copper, and decreased zinc.
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Asad HN, Al-Hakeim HK, Moustafa SR, Maes M. A Causal-Pathway Phenotype of Chronic Fatigue Syndrome due to Hemodialysis in Patients with End-Stage Renal Disease. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:191-206. [PMID: 35366785 DOI: 10.2174/1871527321666220401140747] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/27/2021] [Accepted: 12/24/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND End-stage renal disease (ESRD) is associated with fatigue and physiosomatic symptoms. OBJECTIVE The objective of this study is to delineate the associations between severity of fatigue and physio-somatic symptoms and glomerular filtration rate, inflammatory biomarkers, and Wnt/cateninpathway proteins. METHODS The Wnt-pathway related proteins β-catenin, Dickkopf-related protein 1 (DKK1), R-spondin- 1, and sclerostin were measured by ELISA technique in 60 ESRD patients and 30 controls. The Fibromyalgia and Chronic Fatigue Syndrome (FF) Rating Scale was used to assess the severity of FF symptoms. RESULTS ESRD is characterized by a significant increase in the total FF score, muscle tension, fatigue, sadness, sleep disorders, gastro-intestinal (GI) symptoms, and a flu-like malaise. The total-FF score was significantly correlated with serum levels of urea, creatinine, and copper (positively), and β-catenin, eGFR, hemoglobin, albumin, and zinc (inversely). The total-FF score was associated with the number of total dialysis and weekly dialysis sessions, and these dialysis characteristics were more important in predicting FF scores than eGFR measurements. Partial Least Squares analysis showed that the FF score comprised two factors that are differently associated with biomarkers: a) 43.0% of the variance in fatigue, GI symptoms, muscle tension, sadness, and insomnia is explained by hemoglobin, albumin, zinc, β-catenin, and R-spondin-1; and b) 22.3% of the variance in irritability, concentration and memory impairments by increased copper and cations/chloride ratio, and male sex. CONCLUSION ESRD patients show high levels of fatigue and physio-somatic symptoms associated with hemodialysis and mediated by dialysis-induced changes in inflammatory pathways, the Wnt/catenin pathway, and copper.
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Affiliation(s)
- Halah Nori Asad
- Al Najaf Health Directorate, Higher Health Institute, Najaf, Iraq
| | | | - Shatha Rouf Moustafa
- Department of Clinical Analysis, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, VIC, 3220, Australia
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Zuo M, Zhu W, Lin J, Zhuo J, He X, Jing X, Tang J, Deng R. The impact of nurse-led nonpharmacological multidisciplinary holistic nursing care on fatigue patients receiving hemodialysis: a randomized, parallel-group, controlled trial. BMC Nurs 2022; 21:352. [PMID: 36503477 PMCID: PMC9743541 DOI: 10.1186/s12912-022-01126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Fatigue is a symptom characterized by an elevated prevalence in patients undergoing hemodialysis, which may cause extreme mental and muscular debilitation, significantly influencing social interaction, life quality and well-being. However, the significance of fatigue to patients undergoing hemodialysis has not been recognized yet, and prevention and management of fatigue in this population have not been thoroughly investigated. Additionally, previous studies mainly focused on muscular fatigue, while mental fatigue has been seldom discussed. This study aims to investigate the interaction between nurses and multidisciplinary of nonpharmacological integrated care interventions (NICIs) and assess the impact of fatigue on patients undergoing hemodialysis. METHODS The integrative nonpharmacological care interventions in this study included walking, motivational interviewing (MI) and health education regarding behavioral self-management. A single-center randomized controlled trial was conducted in the dialysis center of the nephrological department in a tertiary affiliated hospital of medical university from January to June 2019. A total of 118 patients were selected and randomly divided into the intervention group (IG) and the control group (CG). Four patients dropped out during the study, and 114 patients were enrolled for the eventual analysis. The 60 patients in the IG received routine nursing combined with integrated care interventions, while the 54 patients in the CG received routine nursing only. This study lasted for six months. RESULTS The experimental group exhibited significant reductions of overall fatigue (2.26 vs. 0.48), mental fatigue (1.41 vs. 0.54), muscular fatigue (2.13 vs. 0.75), and some biochemical indicators (e.g., serum urea) (P<0.05), compared with the CG. CONCLUSIONS Nurses and multidisciplinary teams have been demonstrated to play a key role and interplay function in chronic disease management. Hence, the nurse-led multidisciplinary NICIs significantly alleviated total fatigue (muscular fatigue and mental fatigue) and improved other parameters. TRIAL REGISTRATION ChiCTR-IOR-16008621 (March 18, 2016).
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Affiliation(s)
- Manhua Zuo
- grid.417409.f0000 0001 0240 6969Department of Nursing, Zhuhai Campus of Zunyi Medical University, No. 368 Jinwan Road, Sanzao Town, Jinwan District, Zhuhai, 519041 China
| | - Wensheng Zhu
- Dialysis center, Shanghai Hospital, No. 112 Shanghai Avenue, Wanzhou District, Chongqing, 445000 China
| | - Jinrong Lin
- grid.417409.f0000 0001 0240 6969Department of Foreign Languages, Zhuhai Campus of Zunyi Medical University, No.368 Jinwan Road, Sanzao Town, Jinwan District, Zhuhai, 519041 China
| | - Jing Zhuo
- grid.417409.f0000 0001 0240 6969Teaching department of humanities and social science, Zhuhai Campus of Zunyi Medical University, No.368 Jinwan Road, Jinwan District, Zhuhai, 519041 China
| | - Xirui He
- grid.417409.f0000 0001 0240 6969Department of Bioengineering, Zhuhai Campus of Zunyi Medical University, No.368 Jinwan Road, Sanzao Town, Jinwan District, Zhuhai, 519041 China
| | - Xinghui Jing
- grid.417409.f0000 0001 0240 6969Department of Nephrology, the Fifth affiliated hospital, Zhuhai Campus of Zunyi Medical University, No.1439 Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
| | - Jun Tang
- grid.417409.f0000 0001 0240 6969Department of Nephrology, the Fifth affiliated hospital, Zhuhai Campus of Zunyi Medical University, No.1439 Zhufeng Avenue, Doumen District, Zhuhai, 519100 China
| | - Renli Deng
- grid.417409.f0000 0001 0240 6969Nursing School of Zunyi Medical University, No. 6 Xuefu West Road, Xinpu New District, Zunyi, 563003 China
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Zuo M, Zuo N, Lin J, Zhuo J, Jing X, Tang J. The Effect of Nonpharmacological Integrated Care Protocols on Patients with Fatigue Undergoing Hemodialysis: A Randomized Controlled Trial. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1047959. [PMID: 36299678 PMCID: PMC9592187 DOI: 10.1155/2022/1047959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/25/2022]
Abstract
This study was designed to investigate the effects of nonpharmacological integrated care protocols on fatigue in patients with hemodialysis. This parallel randomized controlled trial was conducted on patients undergoing hemodialysis from May to October 2020 at the Dialysis Center of the Fifth Affiliated Hospital of Zunyi Medical University. The patients were randomized into an intervention group (accepting nonpharmacological integrated care protocols and standard care) or a control group (accepting standard care only) using a computer-generated random number. The nonpharmacological holistic care intervention used in this study involved a well-rounded multidisciplinary team that worked together to improve dietary compliance, medication adherence, and self-management to improve patients' care and promote self-management. From the 120 evaluated patients, 116 cases were eligible and analyzed. The results showed that patients from the intervention group had obviously reduced overall fatigue, mental fatigue, and muscular fatigue relative to the control group. The nonpharmacological integrated care protocols were interactive and promotive to each other. Meanwhile, the role and function of nurses in the management of chronic disease were demonstrated to be crucial.
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Affiliation(s)
- Manhua Zuo
- Department of Nursing, Zhuhai Campus of Zunyi Medical University, No. 368 Jinwan Road, Sanzao Town, Jinwan District, Zhuhai, Guangdong, China
| | - Na Zuo
- Hemodialysis Central, Suining Central Hospital, Suining, Sichuan, China
| | - Jinrong Lin
- Department of Foreign Languages, Zhuhai Campus of Zunyi Medical University, No. 368 Jinwan Road, Sanzao Town, Jinwan District, Zhuhai, China
| | - Jing Zhuo
- Teaching Department of Humanities and Social Science, Zhuhai Campus of Zunyi Medical University, No. 368 Jinwan Road, Jinwan District, Zhuhai, Guangdong Province, China
| | - Xinghui Jing
- Department of Nephrology, The Fifth Affiliated Hospital, Zhuhai Campus of Zunyi Medical University, No. 1439 Zhufeng Avenue, Doumen District, Zhuhai, Guangdong, China
| | - Jun Tang
- Department of Nephrology, The Fifth Affiliated Hospital, Zhuhai Campus of Zunyi Medical University, No. 1439 Zhufeng Avenue, Doumen District, Zhuhai, Guangdong, China
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Abstract
Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring. The use of peritoneal dialysis (PD) can be advantageous compared with haemodialysis treatment, although several barriers limit its broad implementation. This review examines the epidemiology of peritoneal dialysis (PD) outcomes, including clinical, patient-reported and surrogate PD outcomes. Peritoneal dialysis (PD) has distinct advantages compared with haemodialysis, including the convenience of home treatment, improved quality of life, technical simplicity, lesser need for trained staff, greater cost-effectiveness in most countries, improved equity of access to dialysis in resource-limited settings, and improved survival, particularly in the first few years of initiating therapy. Important barriers can hamper PD utilization in low-income settings, including the high costs of PD fluids (owing to the inability to manufacture them locally and the exorbitant costs of their import), limited workforce availability and a practice culture that limits optimal PD use, often leading to suboptimal outcomes. PD outcomes are highly variable around the world owing in part to the use of variable outcome definitions, a heterogeneous practice culture, the lack of standardized monitoring and reporting of quality indicators, and kidney failure care gaps (including health care workforce shortages, inadequate health care financing, suboptimal governance and a lack of good health care information systems). Key outcomes include not only clinical outcomes (typically defined as medical outcomes based on clinician assessment or diagnosis) — for example, PD-related infections, technique survival, mechanical complications, hospitalizations and PD-related mortality — but also patient-reported outcomes. These outcomes are directly reported by patients and focus on how they function or feel, typically in relation to quality of life or symptoms; patient-reported outcomes are used less frequently than clinical outcomes in day-to-day routine care.
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Elsayed MM, Zeid MM, Hamza OMR, Elkholy NM. Dialysis recovery time: associated factors and its association with quality of life of hemodialysis patients. BMC Nephrol 2022; 23:298. [PMID: 36050656 PMCID: PMC9434841 DOI: 10.1186/s12882-022-02926-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/24/2022] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Mohamed Mamdouh Elsayed
- Nephrology and Internal Medicine Department, Faculty of Medicine, Alexandria University, Alkhartoom square, El azareeta, Alexandria, 21131, Egypt.
| | - Montasser Mohamed Zeid
- Nephrology and Internal Medicine Department, Faculty of Medicine, Alexandria University, Alkhartoom square, El azareeta, Alexandria, 21131, Egypt
| | - Osama Mohamed Refai Hamza
- Nephrology and Internal Medicine Department, Faculty of Medicine, Alexandria University, Alkhartoom square, El azareeta, Alexandria, 21131, Egypt
| | - Noha Mohamed Elkholy
- Nephrology and Internal Medicine Department, Faculty of Medicine, Alexandria University, Alkhartoom square, El azareeta, Alexandria, 21131, Egypt
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The effect of a 9-month hybrid intradialytic exercise training program on nerve conduction velocity parameters in patients receiving hemodialysis therapy. Int Urol Nephrol 2022; 54:3271-3281. [PMID: 35789452 DOI: 10.1007/s11255-022-03266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/16/2022] [Indexed: 10/17/2022]
Abstract
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.
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Fatigue in incident peritoneal dialysis and mortality: A real-world side-by-side study in Brazil and the United States. PLoS One 2022; 17:e0270214. [PMID: 35749444 PMCID: PMC9231740 DOI: 10.1371/journal.pone.0270214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background We tested if fatigue in incident Peritoneal Dialysis associated with an increased risk for mortality, independently from main confounders. Methods We conducted a side-by-side study from two of incident PD patients in Brazil and the United States. We used the same code to independently analyze data in both countries during 2004 to 2011. We included data from adults who completed KDQOL-SF vitality subscale within 90 days after starting PD. Vitality score was categorized in four groups: >50 (high vitality), ≥40 to ≤50 (moderate vitality), >35 to <40 (moderate fatigue), ≤35 (high fatigue; reference group). In each country’s cohort, we built four distinct models to estimate the associations between vitality (exposure) and all-cause mortality (outcome): (i) Cox regression model; (ii) competing risk model accounting for technique failure events; (iii) multilevel survival model of clinic-level clusters; (iv) multivariate regression model with smoothing splines treating vitality as a continuous measure. Analyses were adjusted for age, comorbidities, PD modality, hemoglobin, and albumin. A mixed-effects meta-analysis was used to pool hazard ratios (HRs) from both cohorts to model mortality risk for each 10-unit increase in vitality. Results We used data from 4,285 PD patients (Brazil n = 1,388 and United States n = 2,897). Model estimates showed lower vitality levels within 90 days of starting PD were associated with a higher risk of mortality, which was consistent in Brazil and the United States cohorts. In the multivariate survival model, each 10-unit increase in vitality score was associated with lower risk of all-cause mortality in both cohorts (Brazil HR = 0.79 [95%CI 0.70 to 0.90] and United States HR = 0.90 [95%CI 0.88 to 0.93], pooled HR = 0.86 [95%CI 0.75 to 0.98]). Results for all models provided consistent effect estimates. Conclusions Among patients in Brazil and the United States, lower vitality score in the initial months of PD was independently associated with all-cause mortality.
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Abstract
Haemodialysis (HD) is the commonest form of kidney replacement therapy in the world, accounting for approximately 69% of all kidney replacement therapy and 89% of all dialysis. Over the last six decades since the inception of HD, dialysis technology and patient access to the therapy have advanced considerably, particularly in high-income countries. However, HD availability, accessibility, cost and outcomes vary widely across the world and, overall, the rates of impaired quality of life, morbidity and mortality are high. Cardiovascular disease affects more than two-thirds of people receiving HD, is the major cause of morbidity and accounts for almost 50% of mortality. In addition, patients on HD have high symptom loads and are often under considerable financial strain. Despite the many advances in HD technology and delivery systems that have been achieved since the treatment was first developed, poor outcomes among patients receiving HD remain a major public health concern. Understanding the epidemiology of HD outcomes, why they might vary across different populations and how they might be improved is therefore crucial, although this goal is hampered by the considerable heterogeneity in the monitoring and reporting of these outcomes across settings. This Review examines the epidemiology of haemodialysis outcomes — clinical, patient-reported and surrogate outcomes — across world regions and populations, including vulnerable individuals. The authors also discuss the current status of monitoring and reporting of haemodialysis outcomes and potential strategies for improvement. Nearly 4 million people in the world are living on kidney replacement therapy (KRT), and haemodialysis (HD) remains the commonest form of KRT, accounting for approximately 69% of all KRT and 89% of all dialysis. Dialysis technology and patient access to KRT have advanced substantially since the 1960s, particularly in high-income countries. However, HD availability, accessibility, cost and outcomes continue to vary widely across countries, particularly among disadvantaged populations (including Indigenous peoples, women and people at the extremes of age). Cardiovascular disease affects over two-thirds of people receiving HD, is the major cause of morbidity and accounts for almost 50% of mortality; mortality among patients on HD is significantly higher than that of their counterparts in the general population, and treated kidney failure has a higher mortality than many types of cancer. Patients on HD also experience high burdens of symptoms, poor quality of life and financial difficulties. Careful monitoring of the outcomes of patients on HD is essential to develop effective strategies for risk reduction. Outcome measures are highly variable across regions, countries, centres and segments of the population. Establishing kidney registries that collect a variety of clinical and patient-reported outcomes using harmonized definitions is therefore crucial. Evaluation of HD outcomes should include the impact on family and friends, and personal finances, and should examine inequities in disadvantaged populations, who comprise a large proportion of the HD population.
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Bolton S, Gair R, Nilsson LG, Matthews M, Stewart L, McCullagh N. Clinical Assessment of Dialysis Recovery Time and Symptom Burden: Impact of Switching Hemodialysis Therapy Mode. Patient Relat Outcome Meas 2021; 12:315-321. [PMID: 34764715 PMCID: PMC8575372 DOI: 10.2147/prom.s325016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/16/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Most people on hemodialysis (HD) report a high symptom burden. Fatigue and lack of energy are prominent, interfering with daily life and associated with poor outcome. Prolonged recovery time after each of the thrice weekly dialysis treatments is common. The impact of HD therapies, like expanded hemodialysis (HDx), on patient reported recovery time and symptom burden is unclear. Methods A dialysis unit decided to perform regular assessments of patient-reported symptom burden, using the POS-S Renal Symptom questionnaire and the “Recovery time from last dialysis session” question as part of routine patient focused care. At a similar time, a clinical evidence-based decision was taken to switch the in-center dialysis cohort from regular high-flux dialysis membrane to medium cut-off (MCO) membrane, introducing HDx therapy. Results Quarterly assessment of patient-reported symptom burden was well accepted. A sustained clinically relevant reduction in post-dialysis recovery time was observed following the therapy switch. In patients providing data up to 12 months (N = 58), median recovery time decreased from 210 min (IQR 7.5–600) to 60 min (0–210; p = 0.002) and 105 min (0–180; p = 0.001) at 6 and 12 months, respectively. Thirty-six percent of individuals reported a recovery time longer than 360 minutes at the initial assessment, which decreased to 9% at 12 months. The POS-S Renal total symptom score showed a decrease at 6 months but no difference from baseline at 12 months. The “fatigue/lack of energy” symptom showed a sustained improvement; the percentage of participants scoring its impact as “severe” or “overwhelming” decreased from 28% at baseline to 16% at 12 months. Changes in other symptoms were more variable. Conclusion Regular assessment of patient reported symptoms is feasible in routine dialysis practice and can help in evaluating the impact of clinical interventions. Observations suggest that HDx therapy may reduce post-dialysis recovery time and improve perceived fatigue level.
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Affiliation(s)
- Stephanie Bolton
- Renal Unit, Antrim Area Hospital, Northern Health and Social Care Trust, Northern Ireland, UK
| | | | | | - Michael Matthews
- Renal Unit, Antrim Area Hospital, Northern Health and Social Care Trust, Northern Ireland, UK
| | - Louanne Stewart
- Renal Unit, Antrim Area Hospital, Northern Health and Social Care Trust, Northern Ireland, UK
| | - Natasha McCullagh
- Renal Unit, Antrim Area Hospital, Northern Health and Social Care Trust, Northern Ireland, UK
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Tsujimoto Y, Kuratsune D, Kabayama S, Miyazaki M, Watanabe Y, Nishizawa Y, Nakayama M. Amelioration of fatigue in chronic dialysis patients with dialysis solution employing electrolyzed water containing molecular hydrogen (H2) and its association with autonomic function balance. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00376-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Enhanced oxidative stress is involved with fatigue in hemodialysis (HD) patients. Molecular hydrogen (H2) could improve the redox status. Thus, the study examines whether HD solution rendered by electrolyzed water containing H2 (E-HD) could impact the fatigue and autonomic balance of patients.
Methods
This single-arm, prospective observational study examined 95 patients on chronic HD (54 males; mean age and HD duration; 71.4 years and 10.6 years). Fatigue status on HD and HD-free days was compared between control HD (CHD) and 8 weeks after commencement of E-HD, using a visual analog scale (VAS) and an original scale. Autonomic balance was analyzed with the degree of activities of the sympathetic and parasympathetic nervous system via frequency analysis of a continuous beat interval.
Results
Patients were classified into three groups according to the presence of subjective fatigue during the period of CHD: Group A (40.0%), fatigue only on HD days; Group B (11.6%), presence of fatigue on both HD and HD-free days; and Group C (48.4%), freedom from fatigue. During the 8-week observation period of E-HD, VAS scores were significantly decreased on HD days in Group A, while Group B showed no significant changes in VAS on HD days, but significant decreases on HD-free days. No consistent changes were found in Group C. Significant increases in percentages of patients who reported absence of fatigue were seen in Group A on HD days and in Group B on HD-free days in week 8. Regarding changes in autonomic balance parameters after E-HD commencement, a positive correlation was identified between changes in VAS and autonomic balance in Group A.
Conclusion
E-HD may ameliorate fatigue in patients with subjective symptoms on HD and HD-free days. The influence of autonomic balance by E-HD and its impact on fatigue needs to be elucidated.
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Ng MSN, Chan DNS, Cheng Q, Miaskowski C, So WKW. Association between Financial Hardship and Symptom Burden in Patients Receiving Maintenance Dialysis: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189541. [PMID: 34574463 PMCID: PMC8464840 DOI: 10.3390/ijerph18189541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients on maintenance dialysis experience financial hardship. Existing studies are mainly cost analyses that quantify financial hardship in monetary terms, but an evaluation of its impact is also warranted. This review aims to explore the definition of financial hardship and its relationship with symptom burden among patients on dialysis. METHODS A literature search was conducted in November 2020, using six electronic databases. Studies published in English that examined the associations between financial hardship and symptom burden were selected. Two reviewers independently extracted data and appraised the studies by using the JBI Critical Appraisal Checklists. RESULTS Fifty cross-sectional and seven longitudinal studies were identified. Studies used income level, employment status, healthcare funding, and financial status to evaluate financial hardship. While relationships between decreased income, unemployment, and overall symptom burden were identified, evidence suggested that several symptoms, including depression, fatigue, pain, and sexual dysfunction, were more likely to be associated with changes in financial status. CONCLUSION Our findings suggest that poor financial status may have a negative effect on physical and psychological well-being. However, a clear definition of financial hardship is warranted. Improving this assessment among patients on dialysis may prompt early interventions and minimize the negative impact of financial hardship.
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Affiliation(s)
- Marques Shek Nam Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
| | - Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
- Correspondence: ; Tel.: +852-3943-8165
| | - Qinqin Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA 94143, USA;
| | - Winnie Kwok Wei So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
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Gregg LP, Bossola M, Ostrosky-Frid M, Hedayati SS. Fatigue in CKD: Epidemiology, Pathophysiology, and Treatment. Clin J Am Soc Nephrol 2021; 16:1445-1455. [PMID: 33858827 PMCID: PMC8729574 DOI: 10.2215/cjn.19891220] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Fatigue is a commonly reported and debilitating symptom among patients with CKD, yet little is known about its epidemiology, pathogenesis, and treatment. Various measurement tools have been used in published studies to identify and quantify fatigue. These include several single-item measures embedded in longer questionnaires for assessing depression, quality of life, or symptom burden in patients with kidney disease. Approximately 70% of patients with CKD report fatigue, with up to 25% reporting severe symptoms. Patient-reported fatigue is associated with death, dialysis initiation, and hospitalization among individuals with CKD. The pathophysiology is multifactorial and likely includes decreased oxygen delivery and increased reliance on anaerobic metabolism, thus generating lactic acidosis in response to exertion; the effects of chronic metabolic acidosis and hyperphosphatemia on skeletal muscle myocytes; protein-energy wasting and sarcopenia; and depression. Physical activity has been shown to improve fatigue in some small but promising trials, and so should be recommended, given the additional benefits of exercise. Targeting higher hemoglobin levels with erythropoiesis-stimulating agents may improve fatigue, but potential adverse cardiovascular effects preclude their use to solely treat fatigue without the presence of another indication. Current guidelines recommend cautious individualization of hemoglobin targets for those at low cardiovascular risk who still experience fatigue or functional limitation despite a hemoglobin level of 10 g/dl. Sodium bicarbonate supplementation for the treatment of metabolic acidosis may also improve functional status. Selective serotonin reuptake inhibitors have not been consistently shown to improve fatigue in patients with kidney disease, but an ongoing trial will evaluate the effect of alternative antidepressant drug and behavioral activation therapy on fatigue in patients with CKD. Overall, more research is needed to further clarify underlying mechanisms of fatigue and identify effective, targeted treatments for patients with CKD.
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Affiliation(s)
- L. Parker Gregg
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Division of Nephrology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
| | - Maurizio Bossola
- Haemodialysis Unit, Fondazione Policlinico Universitario “Agostino Gemelli,” Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - S. Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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21
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Satta H, Iwamoto T, Kawai Y, Koguchi N, Shibata K, Kobayashi N, Yoshida M, Nakayama M. Amelioration of hemodialysis-induced oxidative stress and fatigue with a hemodialysis system employing electrolyzed water containing molecular hydrogen. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00353-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Abstract
Background
A novel hemodialysis (HD) system employing electrolyzed water containing molecular hydrogen (E-HD) has been developed to improve the bio-compatibility of HD. This study examined the impact of E-HD on changes in redox state during HD and HD-related fatigue.
Method
This single-arm, prospective observational study examined 63 patients on chronic HD (41 males; mean age, 72 ± 9 years; median duration of HD, 7 years). Redox parameters (serum myeloperoxidase [MPO], malondialdehyde-protein adduct [MDA-a], thioredoxin 1 [TRX]) during HD were compared between control HD (C-HD) and E-HD after 8 weeks. Fatigue was evaluated using a numerical rating scale (NRS) during the 8-week course.
Results
In C-HD, an increase in serum MPO accompanied increases in both oxidative products (MDA-a) and anti-oxidant molecules (TRX). In E-HD, although increases in MPO were accentuated during HD, changes in MDA-a and TRX were ameliorated as compared with C-HD. In patients who showed HD-related fatigue (47%) during C-HD, change in MDA-a by HD was a risk factor for the presence of fatigue. During the 8 weeks of observation on E-HD, those patients displayed significant decreases in fatigue scores.
Conclusion
E-HD ameliorates oxidative stress and supports anti-oxidation during HD, suggesting improved bio-compatibility of the HD system. E-HD may benefit patients with HD-related fatigue, but the mechanisms underlying changes to oxidative stress have yet to be clarified.
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22
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Feasibility of an Intradialytic Combined Exercise Program Targeting Older Adults With End-Stage Renal Disease. J Aging Phys Act 2021; 29:905-914. [PMID: 34111843 DOI: 10.1123/japa.2020-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022]
Abstract
Intradialytic exercise is feasible and yields substantial clinical benefits in middle-aged patients. However, evidence is scarce in older hemodialysis patients. OBJECTIVE To assess the feasibility and clinical benefits of supervised, intradialytic exercise in older patients. METHODS Multicenter one-arm feasibility study. The main outcome was feasibility (ease of recruitment, dropout rate, adherence, affective valence, and adverse events). The secondary outcomes were physical capacity (five-repetition sit-to-stand, 60-s sit-to-stand tests, and grip strength), quality of life (36-Item Short-Form Health Survey), quality of sleep (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventory), and dialysis efficacy (Kt/V and urea reduction ratio). RESULTS About 79% of the screened patients agreed to participate (n = 25, 73 [66-77] years). The dropout rate was high (32%), but adherence remained high among the participants who completed the study (94%). Improvements were found in the five-repetition sit-to-stand (p < .001), 60-s sit-to-stand tests (p = .028), 36-Item Short-Form Health Survey mental component score (p = .008), depressive symptoms (p = .006), and quality of sleep (p = .035). CONCLUSION Supervised intradialytic exercise seems safe and beneficial in older patients.
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23
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Comparisons of fatigue between dialysis modalities: A cross-sectional study. PLoS One 2021; 16:e0246890. [PMID: 33566855 PMCID: PMC7875388 DOI: 10.1371/journal.pone.0246890] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background Fatigue is one of the most frequent complications in dialyzed patients and is associated with poorer patient outcomes. Multiple factors are reported to be associated with fatigue development. Of them, the impacts of dialysis modalities remain unknown. Methods A total of 194 dialysis patients (mean age, 61±11 years; 134 males; modalities included hemodialysis (HD) in 26, online hemodiafiltration (HDF) in 74, peritoneal dialysis (PD) in 68, and combined therapy with PD and HD in 26 cases) were recruited for this cross-sectional study. Fatigue was assessed using the Profile of Mood States (POMS), a Visual Analogue Scale (VAS), and our original scale of fatigue, and depression was assessed by the Beck Depression Inventory-second edition (BDI-II). Our original scale of fatigue was administered both on dialysis and dialysis-free days to patients on HD and online HDF. Results The scores of the POMS, VAS, and our original scale were weakly but significantly inter-related (rho = 0.58, P<0.01; rho = 0.47, P<0.01, and rho = 0.42, P<0.01 between POMS and VAS, POMS and our original scale for fatigue, and VAS and our original scale for fatigue, respectively). The scores of these 3 tests showed no significant differences among the 4 modalities. On multivariate analysis, age, body mass index, creatinine, and employment status were associated with the presence or severity of fatigue, whereas dialysis modality was not. A similar result was obtained in 122 patients without depression. The prevalence of fatigue by our original scale was significantly lower on dialysis-free days than on dialysis days in patients on HD and online HDF. Conclusions The results suggest that there is no significant association between different dialysis modalities including HD, online HDF, PD and combined therapy with PD and HD and the prevalence or severity of fatigue.
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24
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Ozen N, Cepken T, Tosun B. Do biochemical parameters and intradialytic symptoms affect post-dialysis recovery time? A prospective, descriptive study. Ther Apher Dial 2021; 25:899-907. [PMID: 33497021 DOI: 10.1111/1744-9987.13624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/09/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022]
Abstract
The recovery time is defined as the time required to recover from the feelings of lassitude and fatigue. The daily activities of patients are affected by dialysis sessions, requiring significant time for patients to return to their routines. This situation implies a lower quality of life for HD patients. The aim of this study was to investigate the effects of biochemical parameters and intradialytic symptoms on post-dialysis recovery time in maintenance HD patients. This study was conducted at a private dialysis center during June and August 2019. Data were collected using the "Descriptive Characteristics Form" and the "Dialysis Symptom Index." "STROBE check-list" was used for the report of the study. The study was completed with 86 participants. The median post-dialysis recovery time was 240 min (interquartile range, 120-360 min), and female patients exhibit significantly higher recovery time than male patients. The median BMI was statistically significantly higher in patients whose post-dialysis recovery time was ≥240 min. Additional findings show that the post-dialysis recovery time was shortened by 0.230 times for male patients, while intradialytic hypotension (IDH) prolonged the median post-dialysis recovery time by 3.141 times. Factors underlying the IDH should be determined in order to eradicate the issue. The study was registered in ClinicalTrials.gov with the number NCT04274556.
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Affiliation(s)
- Nurten Ozen
- Florence Nightingale Hospital School of Nursing, Department of English Nursing, Demiroglu Bilim University, Istanbul, Turkey
| | - Tugba Cepken
- Private Koc Dialysis Center - Beylikduzu, Istanbul, Turkey
| | - Betul Tosun
- Department of Nursing, Hasan Kalyoncu University Faculty of Health Sciences, Gaziantep, Turkey
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25
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Brys ADH, Stifft F, Van Heugten CM, Bossola M, Gambaro G, Lenaert B. Unraveling Fatigue in Hemodialysis Patients: Comparing Retrospective Reports to Real-Time Assessments With an mHealth Experienced Sampling Method. J Pain Symptom Manage 2020; 60:1100-1108.e2. [PMID: 32645453 DOI: 10.1016/j.jpainsymman.2020.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Fatigue is prevalent among hemodialysis (HD) patients and associated with depressive mood. To advance our understanding of its etiology and develop appropriate treatments, reliable measurement instruments are needed. However, conventional fatigue and mood questionnaires are prone to bias because of their retrospective nature and may misrepresent or overestimate actual symptom experience (i.e., the so-called memory-experience gap). Experience sampling methodology (ESM) overcomes this limitation through repeated real-time assessments in patients' natural environment, thereby providing reliable and ecologically valid data. OBJECTIVES We investigated to what extent retrospective symptom reporting accurately represents real-time experiences of fatigue and mood in HD patients using an ESM mobile Health application (PsyMate™; smartHealth GmbH, Luxembourg). METHODS Forty HD patients used the PsyMate for one week to assess real-time fatigue and mood. In addition, they retrospectively evaluated their symptom experience completing end-of-day and end-of-week questionnaires as well as the conventional Fatigue Severity Scale and Hospital Anxiety and Depression Scale. RESULTS Results of real-time observations (N = 1777) showed that fatigue and mood varied between and within individuals. Retrospective end-of-week fatigue evaluation was significantly higher than the average real-time fatigue score; t(38) = 3.54, P = 0.001, and d = 0.57. Fatigue Severity Scale and Hospital Anxiety and Depression Scale correlated moderately to strong with the average ESM score for fatigue and mood: r = 0.66 and r = 0.77, respectively. CONCLUSION Retrospective fatigue assessment may lead to overestimation of real-time symptom experience. ESM provides detailed insight and personalized information about symptom experiences, which may be crucial for the design of more targeted and personalized interventions for fatigue and mood problems in HD patients.
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Affiliation(s)
- Astrid D H Brys
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands; Division of Nephrology, Department of Internal Medicine, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands; Divisione di Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Frank Stifft
- Division of Nephrology, Department of Internal Medicine, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Caroline M Van Heugten
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Maurizio Bossola
- Università Cattolica del Sacro Cuore, Roma, Italy; Hemodialysis Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Gambaro
- Università Cattolica del Sacro Cuore, Roma, Italy; Division of Nephrology, University Hospital of Verona, Verona, Italy
| | - Bert Lenaert
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Limburg Brain Injury Centre, Maastricht, The Netherlands
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26
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Carlos C, Grimes B, Segal M, Johansen K. Predialysis fluid overload and gait speed: a repeated measures analysis among patients on chronic dialysis. Nephrol Dial Transplant 2020; 35:1027-1031. [PMID: 31886859 DOI: 10.1093/ndt/gfz272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/07/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Slow gait speed is associated with hospitalization and death. We examined whether predialysis fluid overload contributes to gait speed impairment. METHODS We measured predialysis gait speed at baseline and 12 and 24 months among 298 patients recruited in the A Cohort Study to Investigate the Value of Exercise in ESRD/Analyses Designed to Investigate the Paradox of Obesity and Survival in ESRD. We used multivariable linear mixed modeling to examine associations between patient data and gait speed. We then added either bioimpedance-estimated volume of predialysis fluid overload or volume of delivered ultrafiltration to ascertain whether fluid excess was associated with gait speed and its trajectory. We also tested whether fluid overload change with time was predictive of gait speeds. RESULTS The mean baseline gait speed was 1.01 m/s and it declined by an average of 0.08 m/s/year. Older age, nonwhite race, Hispanic ethnicity, diabetes, recent fall, recent hospitalization, tobacco use and lower serum albumin were associated with slower gait speed. Each liter of predialysis fluid overload was associated with a 0.02 m/s slower gait speed [95% confidence interval (CI) 0.01-0.04, P = 0.008] and 0.05 m/s additional slowing per year (95% CI 0.03-0.06, P < 0.0001). Higher ultrafiltration volumes were associated with 0.07 m/s slower gait speed per 3% body weight removed (0.002-0.14, P = 0.045) but not with gait speed trajectory (P = 0.08). Patients who increased fluid overload walked 0.08 m/s slower compared with those who decreased fluid overload (95% CI 0.003-0.15, P = 0.04). CONCLUSIONS Predialysis fluid overload was associated with slower gait speed and gait speed decline over time. Interventions that limit fluid overload may lead to improvements in physical performance.
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Affiliation(s)
- Christopher Carlos
- Division of Nephrology, University of California, San Francisco, San Francisco, CA, USA
| | - Barbara Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Mark Segal
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Kirsten Johansen
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA.,Division of Nephrology, University of Minnesota, Minneapolis, MN, USA
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27
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Brys ADH, Stifft F, Van Heugten CM, Bossola M, Gambaro G, Lenaert B. mHealth-based experience sampling method to identify fatigue in the context of daily life in haemodialysis patients. Clin Kidney J 2020; 14:245-254. [PMID: 33564425 PMCID: PMC7857808 DOI: 10.1093/ckj/sfaa124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 06/08/2020] [Indexed: 12/22/2022] Open
Abstract
Background Fatigue in haemodialysis (HD) patients is a prevalent but complex symptom impacted by biological, behavioural, psychological and social variables. Conventional retrospective fatigue questionnaires cannot provide detailed insights into symptom variability in daily life and related factors. The experience sampling methodology (ESM) overcomes these limitations through repeated momentary assessments in patients’ natural environments using digital questionnaires. This study aimed to gain in-depth understanding of HD patients’ diurnal fatigue patterns and related variables using a mobile Health (mHealth) ESM application and sought to better understand the nature of their interrelationships. Methods Forty HD patients used the mHealth ESM application for 7 days to assess momentary fatigue and potentially related variables, including daily activities, self-reported physical activity, social company, location and mood. Results Multilevel regression analyses of momentary observations (n = 1777) revealed that fatigue varied between and within individuals. Fatigue was significantly related to HD treatment days, type of daily activity, mood and sleep quality. Time-lagged analyses showed that HD predicted higher fatigue scores at a later time point (β = 0.22, P = 0.013). Interestingly, higher momentary fatigue also significantly predicted more depressed feelings at a later time point (β = 0.05, P = 0.019) but not the other way around. Conclusions ESM offers novel insights into fatigue in chronic HD patients by capturing informative symptom variability in the flow of daily life. Electronic ESM as a clinical application may help us better understand fatigue in HD patients by providing personalized information about its course and relationship with other variables in daily life, paving the way towards personalized interventions.
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Affiliation(s)
- Astrid D H Brys
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Nephrology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.,Divisione di Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Frank Stifft
- Department of Internal Medicine, Division of Nephrology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Caroline M Van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Maurizio Bossola
- Università Cattolica del Sacro Cuore, Rome, Italy.,Hemodialysis Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Gambaro
- Università Cattolica del Sacro Cuore, Rome, Italy.,Division of Nephrology, University Hospital of Verona, Verona, Italy
| | - Bert Lenaert
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands
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28
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Leme J, Guedes M, Larkin J, Han M, Barra ABL, Canziani MEF, Cuvello Neto AL, Poli-de-Figueiredo CE, de Moraes TP, Pecoits-Filho R. Patient perception of vitality and measured physical activity in patients receiving haemodialysis. Nephrology (Carlton) 2020; 25:865-871. [PMID: 32706161 DOI: 10.1111/nep.13758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
Abstract
AIM Fatigue in haemodialysis (HD) patients can be captured in quality of life questionnaires and by the dialysis recovery time (DRT) question. The associations between fatigue and measured physical activity has not been explored until the present. We tested our hypothesis that the patient perception of chronic and post dialysis fatigue would be associated with lower physical activity. METHODS This study was a cross sectional evaluation of baseline data from HD patients recruited in the HDFIT trial. Vitality scores from the Kidney Disease Quality of Life (KDQOL-36) and the dialysis recovery time (DRT) question were used as indicators of chronic and post dialysis fatigue, respectively. Granular physical activity was measured by accelerometers as part of the study protocol. RESULTS Among 176 patients, Vitality score was 63 ± 21 and the DRT was ≤30 minutes in 57% of patients. The mean number of steps was 5288 ± 3540 in 24 hours after HD and 953 ± 617 in the 2-hour post-HD period. The multivariable analysis confirmed Vitality scores were associated with physical activity in the 24-hour post-HD period. In contrast, DRT was not associated with physical activity captured by the accelerometer in the period immediately (2 hours) after the HD session. CONCLUSION Chronic fatigue was negatively associated with step counts, while patient perception of post-dialysis fatigue was not associated with physical activity. These patterns indicate limitations in interpretation of DRT. Since physical activity is an important component of a healthy life, our results may partially explain the associations between fatigue and poor outcomes in HD patients.
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Affiliation(s)
- Juliana Leme
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Murilo Guedes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - John Larkin
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, USA
| | - Maggie Han
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Renal Research Institute, New York, New York, USA
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29
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Ng MSN, Wong CL, Ho EHS, Hui YH, Miaskowski C, So WKW. Burden of living with multiple concurrent symptoms in patients with end‐stage renal disease. J Clin Nurs 2020; 29:2589-2601. [PMID: 32279368 DOI: 10.1111/jocn.15282] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/24/2020] [Accepted: 03/14/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Marques Shek Nam Ng
- The Nethersole School of Nursing The Chinese University of Hong Kong Hong Kong China
| | - Cho Lee Wong
- The Nethersole School of Nursing The Chinese University of Hong Kong Hong Kong China
| | - Eva Hau Sim Ho
- Department of Medicine Pamela Youde Nethersole Eastern Hospital Hong Kong China
| | - Yun Ho Hui
- Nursing Services Division United Christian Hospital Hong Kong China
| | | | - Winnie Kwok Wei So
- The Nethersole School of Nursing The Chinese University of Hong Kong Hong Kong China
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30
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Ju A, Scholes-Robertson N, Johnson DW, Cho Y, van Zwieten A, Manera K, Howell M, Viecelli AK, Jesudason S, Evangelidis N, Polkinghorne K, Gutman T, Wyburn K, Craig JC, Tong A, Charalambous A, Beach B, Larkin B, Beach C, Clive C, Dingle D, Thomas D, Blake D, Baker D, Underwood D, McLaren D, Demagante F, Jennings G, Jeff H, Mewburn I, Wooldridge J, Ellis J, Widders K, Young K, McLaren K, Yew K, Ellis M, Blake M, Scholes-Robertson N, Scholes-Robertson N, Grant P, Kennedy P, Walter P, Yew P, Jeff R, Wooldridge W. Patient-led identification and prioritization of exercise interventions for fatigue on dialysis: a workshop report. Clin Kidney J 2020; 14:831-839. [PMID: 34840732 PMCID: PMC8612136 DOI: 10.1093/ckj/sfz200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/19/2019] [Indexed: 12/04/2022] Open
Abstract
Background Fatigue is one of the most important symptoms among patients receiving dialysis and is nominated as a core outcome to be reported in all clinical trials in this setting. However, few trials of interventions targeting fatigue have been conducted. Patients historically have rarely been involved in the design of interventions, which can limit acceptability and uptake. When asked, they have indicated a preference for lifestyle interventions, such as exercise, to improve fatigue. While some research has focussed on intradialytic exercise for patients receiving haemodialysis, patients have also indicated a preference for a convenient method of exercising with guidance, but on their own time outside of dialysis hours. In response to this, a mobile phone application was proposed as the method of delivery for a home-based exercise intervention targeting fatigue. Methods We convened a workshop with five breakout group sessions in Australia, with 24 patients on dialysis (16 haemodialysis and 8 peritoneal dialysis) and 8 caregivers to identify, prioritize and discuss exercise interventions for fatigue in patients receiving dialysis and the delivery of this through a mobile application. Results Of the 21 types of exercise identified, the top-ranked were walking outdoors, walking on a treadmill and cardio and resistance training. Six themes were identified: (i) ‘an expectation of tangible gains from exercise’, including strengthening and protecting against bodily deterioration related to dialysis; (ii) ‘overcoming physical limitations’, meaning that comorbidities, baseline fatigue and fluctuating health needed to be addressed to engage in exercise; (iii) ‘fear of risks’, which reinforced the importance of safety and compatibility of exercise with dialysis; (iv) ‘realistic and achievable’ exercise, which would ensure initial readiness for uptake; (v) ‘enhancing motivation and interest’ , which expected to support sustained use of the exercise intervention and (vi) ‘ensuring usability of the mobile application’ , which would require simplicity, convenience and comprehensibility. Conclusion Exercise interventions that are expected by patients to improve health outcomes and that are safe, realistic and easy to adopt may be more acceptable to patients on dialysis.
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Affiliation(s)
- Angela Ju
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Anita van Zwieten
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Karine Manera
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Shilpanjali Jesudason
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Kevan Polkinghorne
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Talia Gutman
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Kate Wyburn
- Department of Transplantation, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
- Colleges of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Sydney, NSW, Australia
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Picariello F, Norton S, Moss-Morris R, Macdougall IC, Chilcot J. A prospective study of fatigue trajectories among in-centre haemodialysis patients. Br J Health Psychol 2019; 25:61-88. [PMID: 31742834 PMCID: PMC7004141 DOI: 10.1111/bjhp.12395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/15/2019] [Indexed: 12/01/2022]
Abstract
Objectives Fatigue is common and debilitating among dialysis patients. The aim of this study was to understand the longitudinal trajectory of fatigue and consider sociodemographic, clinical, and psychological factors that are related to variation in fatigue levels over time. Design A prospective study of fatigue with yearly assessments over 3 years among prevalent in‐centre haemodialysis (HD) patients. Methods Fatigue severity was measured using the Chalder Fatigue Questionnaire and fatigue‐related functional impairment using the Work and Social Adjustment Scale. The trajectories of fatigue outcomes were examined using piecewise growth models, using length of time on dialysis as time. Sociodemographic, clinical, and psychological predictors of fatigue were assessed using linear growth models, using follow‐up time. Results One hundred and seventy‐four prevalent HD patients completed baseline measures, 118 at 12 months, 84 at 24 months, and 66 at 36 months. Fatigue severity scores decreased by 0.15 each year. Fatigue‐related functional impairment increased by 1.17 each year. In adjusted linear growth models, non‐white ethnicity was a significant predictor of lower initial fatigue severity (B = −2.95, 95% CI −5.51 to −0.40) and a greater reduction in fatigue severity of 1.60 each year (95% CI 0.35–2.36). A one‐point increase in damage beliefs was associated with a 0.36 increase in fatigue‐related functional impairment each year (95% CI −0.61 to −0.01). Conclusion Damage beliefs predicted an increase in fatigue‐related functional impairment over time. However, the data strongly suggested that fatigue outcomes vary by length of time on dialysis. Statement of contribution What is already known on this subject?At least 1 in 2 haemodialysis (HD) patients are clinically fatigued. Growing evidence is available on the important role of psychological factors in fatigue across chronic conditions. The contribution of psychological factors, beyond distress, to fatigue in HD has not been examined to date.
What does this study add?Ethnicity played a role in the initial level of fatigue severity and over time. Damage beliefs predicted an increase in fatigue‐related impairment over time. Data strongly suggested that fatigue outcomes vary by length of time on dialysis.
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Affiliation(s)
- Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sam Norton
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Davey CH, Webel AR, Sehgal AR, Voss JG, Huml A. Fatigue in Individuals with End Stage Renal Disease. Nephrol Nurs J 2019; 46:497-508. [PMID: 31566345 PMCID: PMC7047987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Fatigue is a subjective overwhelming feeling of tiredness at rest, exhaustion with activity, lack of energy that impedes daily tasks, lack of endurance, or a loss of vigor. Individuals with end stage renal disease (ESRD) experience a high rate and severity of fatigue. Symptom management of fatigue in this population is critical, since fatigue has been linked with lower quality of life and higher mortality rates. In this article, we present a definition and overview of fatigue, a review of factors contributing to fatigue, and ways to manage fatigue in individuals with ESRD.
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Affiliation(s)
- Christine Horvat Davey
- Research Associate, Case Western Reserve University, Cleveland, OH
- a VAQS Post doctoral Fellow, Cleveland VA, Cleveland, OH
- member of ANNA's Black Swamp Chapter
| | - Allison R Webel
- Associate Professor of Nursing, Case Western Reserve University, Cleveland, OH
| | - Ashwini R Sehgal
- Nephrologist, MetroHealth Medical Center, Cleveland, OH
- Director and Duncan Neuhauser Professor of Community Health Improvement, Center for Reducing Health Disparities School of Medicine, Cleveland, OH
| | - Joachim G Voss
- Professor of Nursing, Case Western Reserve University; and is the Director of the Sarah Cole Hirsh Institute for Evidence-Based Practice, the Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, OH
| | - Anne Huml
- Nephrologist, MetroHealth Medical Center, Cleveland, OH
- Instructor of Medicine, the Center for Reducing Health Disparities, the MetroHealth System, Cleveland, OH
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Risk factors of sleep-disordered breathing in haemodialysis patients. PLoS One 2019; 14:e0220932. [PMID: 31404113 PMCID: PMC6690564 DOI: 10.1371/journal.pone.0220932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022] Open
Abstract
Background Sleep-disordered breathing (SDB) is common in patients with kidney disease; but often underdiagnosed as it is infrequently assessed in clinical practice. The objective of this study was to assess the risk factors of SDB in haemodialysis patients, and to identify useful assessment tools to detect SDB in this population. Methods We used nocturnal oximetry, Epworth Sleepiness Scale (ESS) and STOPBANG questionnaire to screen for SDB in haemodialysis patients. Presence of SDB was defined by Oxygen desaturation index (ODI≥5/h), and further confirmed by apnoea-hypopnea index (AHI) from an in-laboratory polysomnography. Blood samples were collected prior to commencing a haemodialysis treatment. Results SDB was detected in 70% of participants (N = 107, mean age 67 years). STOPBANG revealed that 89% of participants were at risk of SDB; however, only 17% reported daytime sleepiness on the ESS. Of the participants who underwent polysomnography (n = 36), obstructive sleep apnoea was identified in 86%, and median AHI was 34.5/h. Oximetry and AHI results were positively correlated (r = 0.62, P = 0.0001), as were oximetry and STOPBANG (r = 0.48; P<0.0001), but not ESS (r = 0.19; P = 0.08). Multivariate analysis showed that neck circumference (OR: 1.20; 95% CI: 1.07–1.34; P = 0.02) and haemoglobin (OR: 0.93; 95% CI: 0.88–0.97; P = 0.003) were independently associated with the presence of SDB. Conclusion Dialysis patients with a large neck circumference and anaemia are at risk of SDB; using nocturnal oximetry is practical and reliable to screen for SDB and should be considered in routine management of dialysis patients, particularly for those who demonstrate risk factors.
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Gregg LP, Jain N, Carmody T, Minhajuddin AT, Rush AJ, Trivedi MH, Hedayati SS. Fatigue in Nondialysis Chronic Kidney Disease: Correlates and Association with Kidney Outcomes. Am J Nephrol 2019; 50:37-47. [PMID: 31167183 DOI: 10.1159/000500668] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fatigue, although common and associated with outcomes in dialysis-dependent chronic kidney disease (CKD), has not been studied in nondialysis chronic kidney disease (CKD-ND) patients. METHODS In this longitudinal cohort of 266 outpatients with CKD-ND stages 2-5, we measured self-reported fatigue on 3 scales-Quick Inventory of Depression Symptomatology-Self Report (QIDS-SR16), Beck Depression Inventory-I (BDI-I), and short form 12 health survey (SF-12) questionnaires and evaluated the prespecified composite of progression to dialysis initiation, death, or hospitalization after 12 months. Logistic and linear regression assessed characteristics associated with fatigue. Survival analysis measured associations of fatigue with outcomes. RESULTS Mean age was 64.4 ± 12.0 years, and mean estimated glomerular filtration rate (eGFR) was 31.6 ± 16.7 mL/min/1.73 m2. Fatigue was common, with 69.2% reporting fatigue on QIDS-SR16 and 77.7% on BDI-I. Unemployment, comorbidities, use of antidepressant medications, and lower hemoglobin correlated with fatigue. There were 126 outcome events. Participants that reported any versus no fatigue on QIDS-SR16 were more likely to reach the composite, hazard ratio (HR) 1.70 (95% CI 1.11-2.59), which persisted after adjusting for demographics, comorbidities, substance abuse, hemoglobin, albumin, eGFR, and calcium-phosphorus product, HR 1.63 (1.05-2.55). Fatigue severity by the SF-12 was also associated with outcomes independent of demographics, comorbidities, and substance abuse, HR per unit increase 1.18 (1.03-1.35). No association was observed with fatigue on the BDI-I. CONCLUSION Fatigue affected about 2/3 of CKD-ND patients and associated with unemployment, comorbidities, antidepressant medication use, and anemia. Fatigue measured by the QIDS-SR16 and SF-12 independently predicted outcomes in CKD patients. Eliciting the presence of fatigue may be a clinically significant prognostic assessment in CKD patients.
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Affiliation(s)
- L Parker Gregg
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Renal Section, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| | - Nishank Jain
- Division of Nephrology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Division of Nephrology, Department of Medicine, CentralArkansas Veterans Affairs Health Care System, Little Rock, Arkansas, USA
| | - Thomas Carmody
- Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Abu T Minhajuddin
- Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - A John Rush
- Division of Clinical Sciences, Duke-NUS, Singapore, Singapore
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - S Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA,
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Nair D, Finkelstein FO. Toward Developing a Patient-Reported Outcome Measure for Fatigue in Hemodialysis. Am J Kidney Dis 2019; 74:151-154. [PMID: 31155324 DOI: 10.1053/j.ajkd.2019.03.425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Center for Kidney Disease, Nashville, TN
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Does Kidney Transplantation Affect Sleep and Fatigue in Patients With Kidney Disease? Transplant Direct 2019; 5:e461. [PMID: 31321295 PMCID: PMC6553622 DOI: 10.1097/txd.0000000000000895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/15/2019] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Sleep disorders and fatigue are highly prevalent in chronic kidney disease (CKD) and end-stage kidney disease (ESKD) patients but there is limited evidence on the effect of kidney transplant (KTx) on these.
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Nixon AC, Bampouras TM, Pendleton N, Mitra S, Brady ME, Dhaygude AP. Frailty is independently associated with worse health-related quality of life in chronic kidney disease: a secondary analysis of the Frailty Assessment in Chronic Kidney Disease study. Clin Kidney J 2019; 13:85-94. [PMID: 32083613 PMCID: PMC7025341 DOI: 10.1093/ckj/sfz038] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/04/2019] [Indexed: 01/19/2023] Open
Abstract
Background Understanding how frailty affects health-related quality of life (HRQOL) in those with chronic kidney disease (CKD) could assist in the development of management strategies to improve outcomes for this vulnerable patient group. This study aimed to evaluate the relationship between frailty and HRQOL in patients with CKD Stages 4 and 5 (G4–5) and those established on haemodialysis (G5D). Methods Ninety participants with chronic kidney disease (CKD G4–5D) were recruited between December 2016 and December 2017. Frailty was assessed using the Frailty Phenotype, which included assessments of unintentional weight loss, weakness (handgrip strength), slowness (walking speed), physical activity and self-perceived exhaustion. HRQOL was assessed using the RAND 36-Item Health Survey Version 1.0 (SF-36). Results Nineteen (21%) patients were categorized as frail. Frailty, when adjusted for age, gender, dialysis dependence and comorbidity, had a significant effect on five of the eight SF-36 domains: physical functioning, role limitations due to emotional problems, energy/fatigue, social functioning and pain. Regression modelling best explained the variation in the physical functioning domain (adj. R2 = 0.27, P < 0.001), with frailty leading to a 26-point lower score. Exhaustion was the only Frailty Phenotype component that had a significant effect on scores across all SF-36 domains. Conclusions Frailty is independently associated with worse HRQOL in patients with CKD G4–5D, with self-perceived exhaustion being the most significant Frailty Phenotype component contributing to HRQOL. Efforts should be made to identify frail patients with CKD so that management strategies can be offered that aim to improve morbidity, mortality and patient-reported outcomes, including HRQOL and fatigue.
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Affiliation(s)
- Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston,UK.,Centre for Health Research and Innovation, National Institute of Health Research Lancashire Clinical Research Facility, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Theodoros M Bampouras
- Active Ageing Research Group, University of Cumbria, Lancaster, UK.,Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre, University of Manchester, Manchester, UK.,Devices for Dignity, National Institute of Health Research MedTech & In-vitro Diagnostics Co-operative, UK
| | - Mark E Brady
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston,UK
| | - Ajay P Dhaygude
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston,UK
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Clarke AL, Jhamb M, Bennett PN. Barriers and facilitators for engagement and implementation of exercise in end‐stage kidney disease: Future theory‐based interventions using the Behavior Change Wheel. Semin Dial 2019; 32:308-319. [DOI: 10.1111/sdi.12787] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Amy L. Clarke
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School University of Warwick Coventry UK
| | - Manisha Jhamb
- Department of Medicine, Renal‐Electrolyte Division University of Pittsburgh School of Medicine Pittsburgh Pennsylvania
| | - Paul N. Bennett
- Satellite Healthcare San Jose California
- Deakin University Melbourne Vic. Australia
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Mehrotra R, Cukor D, Unruh M, Rue T, Heagerty P, Cohen SD, Dember LM, Diaz-Linhart Y, Dubovsky A, Greene T, Grote N, Kutner N, Trivedi MH, Quinn DK, Ver Halen N, Weisbord SD, Young BA, Kimmel PL, Hedayati SS. Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial. Ann Intern Med 2019; 170:369-379. [PMID: 30802897 DOI: 10.7326/m18-2229] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although depression is common among patients receiving maintenance hemodialysis, data on their acceptance of treatment and on the comparative efficacy of various therapies are limited. OBJECTIVE To determine the effect of an engagement interview on treatment acceptance (phase 1) and to compare the efficacy of cognitive behavioral therapy (CBT) versus sertraline (phase 2) for treating depression in patients receiving hemodialysis. DESIGN Multicenter, parallel-group, open-label, randomized controlled trial. (ClinicalTrials.gov: NCT02358343). SETTING 41 dialysis facilities in 3 U.S. metropolitan areas. PARTICIPANTS Patients who had been receiving hemodialysis for at least 3 months and had a Beck Depression Inventory-II score of 15 or greater; 184 patients participated in phase 1, and 120 subsequently participated in phase 2. INTERVENTION Engagement interview versus control visit (phase 1) and 12 weeks of CBT delivered in the dialysis facility versus sertraline treatment (phase 2). MEASUREMENTS The primary outcome for phase 1 was the proportion of participants who started depression treatment within 28 days. For phase 2, the primary outcome was depressive symptoms measured by the Quick Inventory of Depressive Symptoms-Clinician-Rated (QIDS-C) at 12 weeks. RESULTS The proportion of participants who initiated treatment after the engagement or control visit did not differ (66% vs. 64%, respectively; P = 0.77; estimated risk difference, 2.1 [95% CI, -12.1 to 16.4]). Compared with CBT, sertraline treatment resulted in lower QIDS-C depression scores at 12 weeks (effect estimate, -1.84 [CI, -3.54 to -0.13]; P = 0.035). Adverse events were more frequent in the sertraline than the CBT group. LIMITATION No randomized comparison was made with no treatment, and persistence of treatment effect was not assessed. CONCLUSION An engagement interview with patients receiving maintenance hemodialysis had no effect on their acceptance of treatment for depression. After 12 weeks of treatment, depression scores were modestly better with sertraline treatment than with CBT. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute, Dialysis Clinic, Kidney Research Institute, and National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
- Rajnish Mehrotra
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Daniel Cukor
- State University of New York Downstate Medical Center, Brooklyn, New York (D.C., N.V.)
| | - Mark Unruh
- University of New Mexico, Albuquerque, New Mexico (M.U., D.K.Q.)
| | - Tessa Rue
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Patrick Heagerty
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Scott D Cohen
- George Washington University, Washington, DC (S.D.C.)
| | - Laura M Dember
- University of Pennsylvania, Philadelphia, Pennsylvania (L.M.D.)
| | | | - Amelia Dubovsky
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | - Tom Greene
- University of Utah, Salt Lake City, Utah (T.G.)
| | - Nancy Grote
- University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.)
| | | | | | - Davin K Quinn
- University of New Mexico, Albuquerque, New Mexico (M.U., D.K.Q.)
| | - Nisha Ver Halen
- State University of New York Downstate Medical Center, Brooklyn, New York (D.C., N.V.)
| | - Steven D Weisbord
- Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania (S.D.W.)
| | - Bessie A Young
- Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, Washington (B.A.Y.)
| | - Paul L Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland (P.L.K.)
| | - S Susan Hedayati
- University of Texas Southwestern, Dallas, Texas (M.H.T., S.S.H.)
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Kurita N, Akizawa T, Fukuhara S. Vitality Measured as Self-reported Energy Level and Clinical Outcomes in Hemodialysis Patients: The Japanese Dialysis Outcomes and Practice Pattern Study (J-DOPPS). Am J Kidney Dis 2018; 73:486-495. [PMID: 30528934 DOI: 10.1053/j.ajkd.2018.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/08/2018] [Indexed: 02/08/2023]
Abstract
RATIONALE & OBJECTIVE The infrequent assessment of vitality in clinical practice may be partially due to an inadequate understanding of vitality and the lack of a concise method of assessing it. This study aimed to examine the association of a simple 1-item "vitality" question measuring self-reported energy level with clinical outcomes. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,667 hemodialysis patients participating in the Japanese Dialysis Outcomes and Practice Pattern Study (J-DOPPS), phases 3 to 4 (2005-2011). PREDICTOR Responses to a single question from the 12-item Medical Outcomes Study Short Form survey, version 2.0: "How much time during the past 4 weeks did you have a lot of energy?," recorded using a 5-level Likert scale. OUTCOMES All-cause mortality and a composite of cardiovascular hospitalizations and all-cause mortality. ANALYTICAL APPROACH A pooled ordered logit model was fit to examine correlates of self-reported energy level. Cox and mixed-effects negative binomial regression models were fit for mortality and the composite outcome. RESULTS Lower self-reported energy level was associated with tachycardia and use of benzodiazepines, hypnotics, and antidepressants. In contrast, higher energy was associated with higher single-pool Kt/V, serum albumin concentration, and body mass index. Compared to the lowest energy level, the second-highest and middle levels were associated with lower all-cause mortality (adjusted HRs [aHRs] of 0.66 [95% CI, 0.47-0.93] and 0.75 [95% CI, 0.59-0.96], respectively). Each 1-level higher self-reported energy was associated with lower mortality (aHR, 0.86; 95% CI, 0.78-0.96). Associations between self-reported energy level and multiple cardiovascular hospitalizations and mortality were similar to those between self-reported energy and mortality. LIMITATIONS No psychometric assessments were done for the Short Form survey. CONCLUSIONS The response to a single "vitality" question addressing self-reported energy level is associated with adverse clinical outcomes and correlated with potentially modifiable factors.
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Affiliation(s)
- Noriaki Kurita
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University, Fukushima, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, Fukushima, Japan; Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shunichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, Fukushima, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Bai YL, Chang YY, Chiou CP, Lee BO. Mediating effects of fatigue on the relationships among sociodemographic characteristics, depression, and quality of life in patients receiving hemodialysis. Nurs Health Sci 2018; 21:231-238. [DOI: 10.1111/nhs.12587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 09/20/2018] [Accepted: 10/29/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Yu-Ling Bai
- Department of Nursing; Chung Hwa University of Medical Technology; Tainan Taiwan
| | - Yong-Yuan Chang
- Department of Healthcare Administration and Medical Informatics; Kaohsiung Medical University; Kaohsiung Taiwan
| | | | - Bih-O Lee
- College of Nursing; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Nursing; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
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Yang XH, Zhang BL, Gu YH, Zhan XL, Guo LL, Jin HM. Association of sleep disorders, chronic pain, and fatigue with survival in patients with chronic kidney disease: a meta-analysis of clinical trials. Sleep Med 2018; 51:59-65. [DOI: 10.1016/j.sleep.2018.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/02/2018] [Indexed: 12/17/2022]
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Roumelioti ME, Steel JL, Yabes J, Vowles KE, Vodovotz Y, Beach S, Rollman B, Weisbord SD, Unruh ML, Jhamb M. Rationale and design of technology assisted stepped collaborative care intervention to improve patient-centered outcomes in hemodialysis patients (TĀCcare trial). Contemp Clin Trials 2018; 73:81-91. [PMID: 30208343 PMCID: PMC6168366 DOI: 10.1016/j.cct.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/17/2018] [Accepted: 09/07/2018] [Indexed: 01/08/2023]
Abstract
Most hemodialysis (HD) patients experience symptoms of depression, pain and fatigue that impair their health-related quality of life (HRQOL) significantly. These symptoms are associated with increased hospitalization and mortality, mediated by behavioral factors (e.g. non-adherence to medication and dialysis) and biological factors (e.g. inflammatory cytokines). Prior interventions to alleviate symptoms and improve HRQOL showed limited effectiveness in HD patients and their effect on bio-behavioral mediators is lacking evidence. It is imperative to improve patient-centered dialysis care and to address call from Kidney Disease Improving Global Outcomes (KDIGO) guidelines for integration of symptom assessment and management in routine HD-care. Technology-Assisted stepped Collaborative Care (TĀCcare) is a multi-center randomized controlled trial (RCT) of 150 diverse HD patients from Pennsylvania and New Mexico, designed to compare the effectiveness of a 12-week stepped collaborative care intervention (cognitive behavioral therapy, CBT) with an attention control arm of technology-delivered health education. Collaborative care provides an integrated multi-disciplinary structured management plan. Furthermore, a stepped approach to pharmacotherapy and/or CBT allows for individualization of treatment according to patients' clinical status, preferences and treatment response. To simplify the delivery of CBT and to minimize patient and provider burden, we will use live video-conferencing with patients in dialysis units. We will examine the effect of these interventions on patient symptoms, HRQOL, treatment adherence and inflammatory biomarkers. This RCT tests a readily implementable intervention that can be integrated in routine HD-care and will generate novel and meaningful insights on strategies to alleviate common symptoms and improve HRQOL in HD.
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Affiliation(s)
- Maria-Eleni Roumelioti
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine Albuquerque, NM, United States
| | - Jennifer L Steel
- Department of Surgery, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jonathan Yabes
- Center for Research on Heath Care, Division of General Internal Medicine, Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kevin E Vowles
- Department of Psychology, University of New Mexico & Division of Physical Medicine and Rehabilitation, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Yoram Vodovotz
- Department of Immunology and Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Scott Beach
- Department of Psychology, University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bruce Rollman
- Department of Medicine, Psychiatry, Biomedical Informatics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven D Weisbord
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Mark L Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine Albuquerque, NM, United States
| | - Manisha Jhamb
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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Zyga S, Alikari V, Sachlas A, Fradelos EC, Stathoulis J, Panoutsopoulos G, Georgopoulou M, Theophilou P, Lavdaniti M. Assessment of Fatigue in End Stage Renal Disease Patients Undergoing Hemodialysis: Prevalence and Associated Factors. Med Arch 2018; 69:376-80. [PMID: 26843728 PMCID: PMC4720468 DOI: 10.5455/medarh.2015.69.376-380] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Sofia Zyga
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Lakonia, Greece
| | - Victoria Alikari
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Lakonia, Greece
| | - Athanasios Sachlas
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Lakonia, Greece
| | - Evangelos C Fradelos
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Lakonia, Greece
| | - John Stathoulis
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Lakonia, Greece
| | - Georgios Panoutsopoulos
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Lakonia, Greece
| | | | | | - Maria Lavdaniti
- Department of Nursing, Technological educational institute of Thessaloniki, Thessaloniki, Greece
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Picariello F, Norton S, Moss-Morris R, Macdougall IC, Chilcot J. Fatigue in Prevalent Haemodialysis Patients Predicts All-cause Mortality and Kidney Transplantation. Ann Behav Med 2018; 53:501-514. [DOI: 10.1093/abm/kay061] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 5th floor Bermondsey Wing, Guy’s Campus, London Bridge, London, UK
| | - Sam Norton
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 5th floor Bermondsey Wing, Guy’s Campus, London Bridge, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 5th floor Bermondsey Wing, Guy’s Campus, London Bridge, London, UK
| | | | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 5th floor Bermondsey Wing, Guy’s Campus, London Bridge, London, UK
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Cataldo E, Columbano V, Nielsen L, Gendrot L, Covella B, Piccoli GB. Phosphate binders as a cause of hypothyroidism in dialysis patients: practical indications from a review of the literature. BMC Nephrol 2018; 19:155. [PMID: 29966512 PMCID: PMC6027573 DOI: 10.1186/s12882-018-0947-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/14/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although fatigue is common in dialysis patients, polypharmacy is seldom listed among its causes. In this report, we describe a dialysis patient who developed severe fatigue due to pharmacological interaction between two commonly prescribed drugs, phosphate binders and levothyroxine. CASE PRESENTATION A 65-year old woman, on dialysis for 17 years, complained of fatigue (weight 54 Kg, height 1.55 m, BMI: 23 Kg/m2; malnutrition inflammation index: 10; Charlson index 9). She had been treated with lithium for about 20 years. A heavy smoker, she was obese and diabetic when young, but stopped treatment after weight loss. She had undergone thyroidectomy for papillary carcinoma, left hemicolectomy for colon adenocarcinoma, left quadrantectomy followed by radiotherapy for ductal mammary adenocarcinoma, subtotal parathyroidectomy for tertiary hyperparathyroidism. At the time of this report, she was on thrice-weekly hemodiafiltration (Daugirdas 2 Kt/V: 1.6-1.8). Her recent treatment included spironolactone, amlodipine, perindopril, valproate, lamotrigine, levothyroxine, vitamin D, calcium carbonate, sodium polystyrene and sevelamer. After she questioned her doctor about whether her fatigue might be the result of a drug interaction, levothyroxine interference was identified (TSH, previously normal, increased to 13.07 mU/L, after increasing sevelamer dose, and normalized after change of drug schedule). LITERATURE REVIEW only 5 relevant papers on levothyroxine and phosphate binders on dialysis were found on Pubmed and EMBASE (out of 351 titles retrieved). Information was therefore inferred from studies in normal volunteers or in other diseases. DISCUSSION AND CONCLUSIONS Our case differs from other reports on lower TSH at diagnosis, underlining the need for awareness of the importance of early diagnosis. Integrating the scant literature on dialysis patients with data available in the general population, some working conclusions can be reached: while all phosphate binders potentially interfere with levothyroxine absorption, interference seems to be highest for sevelamer; interference is limited but not excluded by increasing the intervals between drugs; morning fast is usually indicated but, when clashing with the timing of other drugs, a bedtime dose and liquid preparations may be indicated. In the absence of an agreed control schedule, our case supports close monitoring of TSH (1-3 months if unstable, twice-yearly in stable patients).
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Affiliation(s)
- Emanuela Cataldo
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France
- Nefrologia, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Valeria Columbano
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France
- Nefrologia, Università della Campania "Luigi Valvitelli", Naples, Italy
| | - Louise Nielsen
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France
| | - Lurlynis Gendrot
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France
| | - Bianca Covella
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France
- Nefrologia, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Giorgina Barbara Piccoli
- Néphrologie Centre Hospitalier le Mans, Avenue Roubillard, 72000, Le Mans, France.
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy.
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Bossola M, Di Stasio E, Marzetti E, De Lorenzis K, Pepe G, Vulpio C. Fatigue is associated with high prevalence and severity of physical and emotional symptoms in patients on chronic hemodialysis. Int Urol Nephrol 2018; 50:1341-1346. [PMID: 29728992 DOI: 10.1007/s11255-018-1875-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/17/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE The symptom burden of fatigued hemodialysis patients is poorly known. We aimed to investigate possible differences in the prevalence and severity of symptoms between fatigued and not fatigued patients on chronic hemodialysis. METHODS All prevalent patients on chronic hemodialysis referring to the Hemodialysis Service between January 2016 and June 2017 were considered eligible. The Dialysis Symptom Index (DSI) questionnaire was performed during the dialysis treatment. Patients underwent assessment of fatigue using the Italian version of the vitality scale of the SF-36 (SF-36VS). RESULTS We studied 137 patients: 107 (78.1%) were fatigued and 30 (31.9%) were non-fatigued. The median [95% CI] number of symptoms was 15 [14-16] for patients who reported fatigue and 9 [8-19] for the non-fatigued (P < 0.0001). In fatigued patients, with respect to non-fatigued ones, the prevalence of dry skin, itching, muscle soreness, bone or joint pain, restless legs, shortness of breath, feeling sad, feeling anxious, difficulty concentrating, and difficulty becoming sex aroused was significantly higher. Restless legs, feeling sad, difficulty concentrating, and difficulty becoming sex aroused were symptoms independently associated with fatigue. The severity of dry skin, trouble staying asleep, and bone/joint pain was higher in fatigued patients. CONCLUSION Fatigued hemodialysis patients report suffering from physical and emotional symptoms more frequently than non-fatigued patients. This finding suggests the need to accurately and routinely define the symptom burden of chronic hemodialysis patients and may help to investigate eventually common underlying pathogenic mechanisms of symptoms in these patients.
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Affiliation(s)
- Maurizio Bossola
- Hemodialysis Service, Institute of Clinical Surgery, Catholic University of the Sacred Heart, Rome, Italy.
| | - Enrico Di Stasio
- Department of Clinical Chemistry, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuele Marzetti
- Department of Geriatrics and Gerontology, Catholic University of the Sacred Heart, Rome, Italy
| | - Katja De Lorenzis
- Nurse Team Hemodialysis Service, Catholic University of the Sacred Heart, Rome, Italy
| | - Gilda Pepe
- Department of Emergency Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Vulpio
- Hemodialysis Service, Institute of Clinical Surgery, Catholic University of the Sacred Heart, Rome, Italy
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Relationship between fatigue symptoms and subjective and objective indicators in hemodialysis patients. Int Urol Nephrol 2018; 50:1329-1339. [PMID: 29728995 DOI: 10.1007/s11255-018-1871-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/11/2018] [Indexed: 02/05/2023]
Abstract
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.
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Picariello F, Moss‐Morris R, Macdougall IC, Chilcot J. 'It's when you're not doing too much you feel tired': A qualitative exploration of fatigue in end-stage kidney disease. Br J Health Psychol 2018; 23:311-333. [PMID: 29280249 PMCID: PMC5900909 DOI: 10.1111/bjhp.12289] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 11/08/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Fatigue is commonly experienced in end-stage kidney disease (ESKD) patients. In order to develop patient-centred psychosocial interventions to help patients manage fatigue symptoms, a more in-depth understanding regarding the experience of fatigue is needed. OBJECTIVE The objective of this study was to explore renal patients' experiences of fatigue, across renal replacement therapy (RRT) modalities. METHODS Twenty-five in-depth semi-structured interviews were conducted. Interviews were audio-taped, transcribed, and analysed using inductive thematic analysis. RESULTS Main themes included the strong role of the illness and treatment in the aetiology of fatigue. Two contrasting streams of illness-fatigue interpretations emerged: catastrophizing versus normalizing. Participants emphasized the importance of having a sense of purpose in facilitating active management of fatigue. Many participants described the consequences of fatigue on their functioning. Low mood, frustration, and anger were common emotional consequences of fatigue. Three dominant fatigue management strategies emerged: one related to accommodation of activities around fatigue, another on increasing activities to counteract fatigue, and the third one revolved around self-compassion. Social support emerged as an important aspect of the fatigue experience, serving as a source of motivation, yet participants were wary of becoming a burden to others. CONCLUSION Findings identify casual attributions, behavioural and emotional reactions, management strategies, and facilitators of active management of fatigue in ESKD. Untying fatigue from the illness and treatment may help patients to develop alternative less catastrophic perceptions of fatigue, increase their perception of control over fatigue, and facilitate active fatigue management. Statement of contribution What is already known on this subject? Fatigue is persistent and debilitating in end-stage kidney disease (ESKD), with no consistent treatment model. Promising evidence is available for psychological fatigue interventions in other chronic conditions. There is a gap in studies looking at the fatigue experiences of patients with ESKD across renal replacement therapies. What does this study add? Fatigue is not inherently negative, but shaped by patients' beliefs and behaviours. Findings provide novel insights, for example, on the important role social support seems to play in fatigue. An in-depth understanding of fatigue may help to inform a future patient-centred intervention in ESKD.
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Affiliation(s)
- Federica Picariello
- Health Psychology SectionPsychology DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonUK
| | - Rona Moss‐Morris
- Health Psychology SectionPsychology DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonUK
| | | | - Joseph Chilcot
- Health Psychology SectionPsychology DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonUK
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Picariello F, Moss-Morris R, Macdougall IC, Norton S, Da Silva-Gane M, Farrington K, Clayton H, Chilcot J. Cognitive-behavioural therapy (CBT) for renal fatigue (BReF): a feasibility randomised-controlled trial of CBT for the management of fatigue in haemodialysis (HD) patients. BMJ Open 2018; 8:e020842. [PMID: 29523571 PMCID: PMC5855165 DOI: 10.1136/bmjopen-2017-020842] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/01/2018] [Accepted: 02/12/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Fatigue is one of the most common and disabling symptoms in end-stage kidney disease, particularly among in-centre haemodialysis patients. This two-arm parallel group feasibility randomised controlled trial will determine whether a fully powered efficacy trial is achievable by examining the feasibility of recruitment, acceptability and potential benefits of a cognitive-behavioural therapy (CBT)-based intervention for fatigue among in-centre haemodialysis patients. METHODS We aim to recruit 40 adult patients undergoing in-centre haemodialysis at secondary care outpatient dialysis units, who meet clinical levels of fatigue. Patients will be randomised individually (using a 1:1 ratio) to either a 4-6 weeks' CBT-based intervention (intervention arm) or to a waiting-list control (control arm). The primary feasibility outcomes include descriptive data on numbers within each recruiting centre meeting eligibility criteria, rates of recruitment, numbers retained postrandomisation and treatment adherence. To assess the potential benefits of the cognitive-behavioural therapy for renal fatigue intervention, secondary self-report outcomes include measures of fatigue severity (Chalder Fatigue Questionnaire), fatigue-related functional impairment (Work and Social Adjustment Scale), sleep quality (Pittsburgh Sleep Quality Index), depression (Patient Health Questionnaire-9) and anxiety (Generalised Anxiety Disorder-7). Changes in fatigue perceptions (Brief Illness Perception Questionnaire), cognitive and behavioural responses to fatigue (Cognitive and Behavioural Responses to Symptoms Questionnaire), sleep hygiene behaviours (Sleep Hygiene Index) and physical activity (International Physical Activity Questionnaire-short form) will also be explored. These self-report measures will be collected at baseline and 3 months postrandomisation. Nested qualitative interviews will be conducted postintervention to explore the acceptability of the intervention and identify any areas in need of improvement. The statistician and assessor will be blinded to treatment allocation. ETHICS AND DISSEMINATION A National Health Service (NHS) Research Ethics Committee approved the study. Any amendments to the protocol will be submitted to the NHS Committee and study sponsor. TRIAL REGISTRATION NUMBER ISRCTN91238019;Pre-results.
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Affiliation(s)
- Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Sam Norton
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maria Da Silva-Gane
- Department of Renal Medicine, Lister Hospital, Stevenage, UK
- University of Hertfordshire, Hertfordshire, UK
| | - Ken Farrington
- Department of Renal Medicine, Lister Hospital, Stevenage, UK
- University of Hertfordshire, Hertfordshire, UK
| | - Hope Clayton
- Department of Renal Medicine, Lister Hospital, Stevenage, UK
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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