Multiple Dimensions And Correlates Of Fatigue In Individuals On Hemodialysis: A Quantitative Study

Background: Fatigue is present in individuals on Hemodialysis (HD). Evidence on fatigue in HD are limited by focus on unidimensional aspect of fatigue, flawed unidimensional tools, lack of objective measures, and variability in the correlates of fatigue. Purpose: To examine severity and trajectory pattern of fatigue; delineate influencing physiological and situational factors pre-dialysis and post-dialysis. Theoretical Framework: The Theory of Unpleasant Symptoms was used to guide the study. Methodology: A descriptive, correlational, before-after design was utilized. Measures were Piper Fatigue Scale (PFS)-12, Patient Reported Outcomes Measurement Information Systems (PROMIS)-Fatigue, Charlson Comorbidity Index and six-minute walk test (6MWT). Adults, cognitively intact patients on HD were included; patients with limited mobility, heart issues and abnormal vital signs were excluded for the 6MWT. Results: Sample was 86 participants, 24-89 years old, 58.1% males, and 51.1% non-whites. In terms of prevalence, 90% of the patients were fatigued pre-dialysis whereas 85% of the patients were fatigued post-dialysis. Most individuals were moderately fatigued pre-dialysis and most were mildly and moderately fatigued post-dialysis. The mean scores of fatigue based on PFS-12 increased after dialysis, however, no statistical difference was observed. In terms of quality of fatigue, high ‘affective fatigue’ mean scores were reported before and after dialysis session. An increase in sensory and cognitive fatigue was observed from pre-dialysis to the post-dialysis period. In terms of frequency,70% patients said that they had fatigue ‘often’ or ‘sometimes’ in the past 7 days. The mean PROMIS fatigue score was significantly higher than average U.S. population. Individuals walked significantly further during 6-minute walk test pre-dialysis than post-dialysis, that indicates patients are physically fatigued. Fatigue was severe in individuals with low hemoglobin values, inadequate dialysis, comorbidities, young age group and individuals who lived with someone. Conclusion: Prevalence of fatigue is higher in dialysis than general population, and fatigue escalates after dialysis. Therapies that can target sensory, cognitive and physical fatigue may be helpful in alleviation of fatigue in these patients. A better understanding of fatigue will eventually help in better management of chronic kidney disease and contribute to a better quality of life in this population