Fatigue in Patients Receiving Maintenance Hemodialysis: A Review.

Authors

Maurizio Bossola
S Susan Hedayati
Astrid D H Brys
L Parker Gregg

Publication Date

10-1-2023

Journal

American Journal of Kidney Diseases

DOI

10.1053/j.ajkd.2023.02.008

PMID

37187283

PMCID

PMC11571972

PubMedCentral® Posted Date

11-18-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Quality of Life, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Renal Dialysis, Fatigue, fatigue, hemodialysis, post-dialysis fatigue, intra-dialytic fatigue

Abstract

Fatigue surrounding hemodialysis treatments is a common and often debilitating symptom that impacts patients' quality of life. Intradialytic fatigue develops or worsens immediately before hemodialysis and persists through the dialysis treatment. Little is known about associated risk factors or pathophysiology, although it may relate to a classic conditioning response. Postdialysis fatigue (PDF) develops or worsens after hemodialysis and may persist for hours. There is no consensus on how to measure PDF. Estimates for the prevalence of PDF range from 20%-86%, likely due to variation in methods of ascertainment and participant characteristics. Several hypotheses seek to explain the pathophysiology of PDF, including inflammation, hypothalamic-pituitary-adrenal axis dysregulation, and osmotic and fluid shifts, but none is currently supported by compelling or consistent data. PDF is associated with several clinical factors, including cardiovascular and hemodynamic effects of the dialysis procedure, laboratory abnormalities, depression, and physical inactivity. Clinical trials have reported hypothesis-generating data about the utility of cold dialysate, frequent dialysis, clearance of large middle molecules, treatment of depression, and exercise as potential treatments. Existing studies are often limited by sample size, lack of a control group, observational design, or short intervention duration. Robust studies are needed to establish the pathophysiology and management of this important symptom.