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Correlates and Outcomes of Fatigue among Incident Dialysis Patients

Manisha Jhamb^*, Christos Argyropoulos, Jennifer L. Steel, Laura Plantinga, Albert W. Wu, Nancy E. Fink, Neil R. Powe, Klemens B. Meyer^||, Mark L. Unruh, and for the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study

^* Department of Medicine, Western Pennsylvania Hospital, Pittsburgh, Pennsylvania; Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery and Psychiatry, University of Pittsburgh School of Medicine; Department of Epidemiology, Johns Hopkins University, Baltimore Maryland; and ^|| Division of Nephrology, Tufts Medical Center, Boston, Massachusetts

Correspondence: Dr. Mark Unruh,University of Pittsburgh Medical Center, Renal-Electrolyte Division, 3550 Terrace Street, A909 Scaife Hall, Pittsburgh, PA 15261. Phone: 412-647-2561; Fax: 412-647-6891; E-mail: unruh{at}pitt.edu

Background & objectives: Fatigue is a debilitating symptom experienced by patients undergoing dialysis, but there is only limited information on its prevalence and its association with patient outcomes. This study examines the correlates of self-reported fatigue at initiation of dialysis and after 1 yr and assesses the extent to which fatigue was associated with health-related quality of life and survival.

Design, setting, participants, & measurements: A longitudinal cohort of 917 incident hemodialysis and peritoneal dialysis patients who completed the CHOICE Health Experience Questionnaire (CHEQ) participated in the study. Fatigue was assessed using the SF-36 vitality scale. Known predictors of fatigue including sociodemographic and psychosocial factors, dialysis-related factors, biochemical variables including inflammatory markers, comorbidities, and medications were used as covariates.

Results: A low vitality score was independently associated with white race, higher Index of Coexistent Disease score, higher body mass index, lack of physical exercise, antidepressant use, and higher C-reactive protein levels (CRP). A lower vitality score was strongly associated with lower SF-36 physical functioning, mental health, bodily pain scores, and decreased sleep quality (all P < 0.001) at baseline. Among surviving participants, higher serum creatinine at baseline was associated with preserved vitality at 1 yr. Patients with the highest baseline vitality scores were associated with longer survival (hazard ratio 0.75; 95% CI 0.58 to 0.96, P = 0.03).

Conclusions: The findings of this study demonstrate that ESRD patients experience profound levels of fatigue and elucidate its correlates. Also, the association of fatigue with survival may have significant implications for this population.