Fatigue is a debilitating symptom or side effect experienced by many patients
on long-term dialysis. Fatigue has a considerable effect on p
atients’ health-related quality of life and is viewed as being more important
than survival by some patients. There are many challenges renal providers face
when attempting to reduce fatigue in dialysis patients. The lack of a reliable,
valid, and sensitive fatigue scale complicates the accurate identification of
this symptom. Symptoms of daytime sleepiness and depression overlap with
fatigue, making it difficult to target specific therapies. Moreover, many
chronic health conditions common in the long-term dialysis population may lead
to the development of fatigue and contribute to the day-to-day and diurnal
variation of fatigue in patients. Key to improving the assessment and treatment
of fatigue is improving our understanding of potential mediators, as well as
potential therapies. Cytokines have emerged as an important mediator of fatigue
and have been studied extensively in cancer related fatigue. In addition,
although erythropoietin stimulating agents (ESA) have been shown to mitigate
fatigue, the recent controversy regarding ESA dosing in chronic kidney disease
(CKD) suggests that ESA therapy may not serve as the sole therapy to improve
fatigue in this population. In conclusion, fatigue is an important and often
under-recognized symptom in the dialysis population. Possible interventions for
minimizing fatigue in patients on long-term dialysis should be aimed at
improving health care provider awareness, developing improved methods of
measurement, better understanding of the pathogenesis, as well as management of
known contributing factors.
Contributors to Fatigue in ESRD
In the dialysis population, physiologic, behavioral, treatment-related, and
individual characteristics may be correlated with fatigue . Physiologic
etiologies include anemia, malnutrition, uremia, dialysis inadequacy,
hyperparathyroidism, coexisting chronic illnesses, sleep disorders, depression
and side effects of medications. Dietary and fluid restriction may also play a
role. Physical inactivity has been associated with higher levels of fatigue.
Socio-demographic factors including age, sex, race, educational, marital, and
vocational status may also play a role in the experience of fatigue in dialysis
patients, In a study among HD patients in Taiwan, higher levels of fatigue were
reported by female, older and unemployed patients. It is also important to note
that pro-inflammatory cytokines have emerged as potential mediators of fatigue,
providing a common biological pathway for physiologic, behavioral, and
treatment-related factors to cause fatigue in the dialysis population.
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