Fatigue in Individuals with End Stage Renal Disease.
Christine Horvat Davey, Allison R Webel, Ashwini R Sehgal and 2 others
PMID 31566345WHAT IT FOUND
Fatigue affects 60% to 97% of people with end-stage renal disease on hemodialysis, and nurses should ask about it regularly.
Causes and treatments are unclear, so manage it as a common, burdensome symptom while checking depression, activity, and anemia.
Key findings
01Fatigue affects 60% to 97% of individuals with ESRD undergoing hemodialysis and is linked with lower quality of life, worse daily activity, cardiovascular events, and higher mortality.
02Causes remain unclear: demographic and renal laboratory associations are inconclusive, while higher body mass index, more co-morbidities, lower physical activity, and depression have stronger evidence.
03Management is limited by no standard fatigue measure or standardized interventions; exercise may be safe and positive, erythropoiesis-stimulating agents may improve fatigue when baseline hemoglobin is less than 10 g/dL, and acupressure or TEAS evidence is low quality.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
This is a narrative review, not a single trial, so it cannot show that one fatigue intervention caused a measured improvement. Many included studies were small and cross-sectional, which makes it hard to follow fatigue over time or rule out chance. There is no gold-standard fatigue measure in ESRD, so studies used different tools and results are hard to compare. Associations with physical activity, depression, and social support may be bidirectional, so the review cannot prove cause and effect. Intervention studies were not standardized, and acupressure or TEAS evidence was very low quality, with severe adverse events and pain outcomes not assessed. The counselling trial was still ongoing at the time of the review, so its results were not available.
Declared interests
The authors reported no actual or potential conflict of interest.
The easy way to misread this
Do not read this review as proof that exercise, acupressure, vitamin C, L-carnitine, or anemia correction reliably reduces fatigue. The evidence comes from heterogeneous studies with small samples, cross-sectional designs, non-standardized interventions, and no gold-standard fatigue measure, so the contribution of any single treatment is unclear.