Prevalence and Severity of Postdialysis Fatigue Are Higher in Patients on Chronic Hemodialysis With Functional Disability

The aim of the present study was to deter-mine the intensity, duration, frequency and prevalence ofpostdialysis fatigue (PDF) in patients on chronic hemodialy-sis (PCD) with and without functional disability. Patientsunderwent assessment of functional ability by the KatzADL (activity daily living) questionnaire and the Lawtonand Brody scale for the instrumental activity daily living(IADL) fatigue using the SF-36 Vitality Subscale, comorbid-ity through the Charlson comorbidity score index (CDI),and time of recovery after hemodialysis (TIRD). We stud-ied 271 PCD. ADL and IADL disabilities were present in75 (27.6%) and 168 (62%) patients, respectively. Patientswith ADL disability were significantly older and showedhigher CDI scores, and lower levels of serum albumin andKt/V. Prevalence of PDF was significantly higher in patientswith ADL disability as well as its severity, intensity,duration and frequency. Patients with IADL disability weresignificantly older, had a higher CCI score, had lower levelsof serum albumin and Kt/V, and had a higher severity,intensity, duration and frequency of PDF. At multivariateregression analysis, ADL disability was positively associatedwith age, prevalence and severity of PDF, and dialysatetemperature and inversely associated with serum albuminlevels. IADL disability was instead positively associatedwith age and dialysate temperature and inversely associatedwith serum albumin levels. In conclusion, prevalence andseverity of PDF are significantly higher in PCD with ADLdisability than in those without it. This knowledge may haveimportant implications for the development of interventionsto reduce PDF in PCD

Prevalence and associated variables of postdialysis fatigue: results of a prospective multicenter study

AIMS: Little is known about postdialysis fatigue (PDF), a debilitating symptom of hemodialysis patients. METHODS: In 5 hemodialysis units of northern-centre Italy, patients were regarded to suffer from PDF if they spontaneously offered this complaint when asked the open-ended question: Do you feel better or worse after dialysis? If worse, please specify in which way. A complaint of fatigue would be probed further with questions directed at its duration, frequency and intensity, allowing creation of a fatigue index of severity (one third of the sum of these three parameters, each rated from 1 to 5). Patients were stratified into three groups according the severity of PDF: 1) score\u2009=\u20090; 2) score\u2009=\u20091-3; 3) score\u2009>\u20093. RESULTS: We studied 271 patients: 164 had PDF and 107 had not. PDF patients had significantly longer time of recovery after dialysis (TIRD). TIRD was significantly associated with PDF duration, intensity, and frequency. Patients with PDF were older and had a lower ADL score. At multivariate analysis, PDF was significantly associated with TIRD. In multivariate model that did not include TIRD, PDF was independently associated with age and ADL. Sixty patients had moderate PDF and 104 severe PDF. In patients with severe PDF, age and dialytic age were higher, ADL and IADL scores were lower, TIRD was longer and the ultrafiltration rate was lower. At multivariate analysis, PDF severity was independently associated with TIRD. In the model without TIRD, PDF severity was associated with ADL only. CONCLUSION: PDF is frequent and associated with age and ADL. Dialytic variables seem unrelated to PDF