From the Guidelines
People are tired after dialysis primarily due to the physical stress the procedure places on the body, with fatigue being the most common symptom reported by individuals undergoing either hemodialysis or peritoneal dialysis 1. Dialysis removes waste products, excess fluid, and toxins from the blood, which is an intensive process that can deplete energy levels. During treatment, rapid changes in blood pressure, fluid levels, and electrolyte balance occur, causing fatigue. The removal of fluid can lead to dehydration-like symptoms, while the filtering process may temporarily remove some beneficial nutrients along with waste products. Many patients also experience anemia due to decreased kidney production of erythropoietin, the hormone that stimulates red blood cell production, further contributing to fatigue. The psychological stress of regular dialysis treatments, disrupted sleep patterns from scheduling, and underlying kidney disease itself all compound this fatigue.
To manage post-dialysis tiredness, patients should ensure adequate rest after treatments, maintain proper nutrition with sufficient protein intake, take prescribed medications like erythropoietin supplements if recommended, stay hydrated appropriately between sessions, and discuss persistent severe fatigue with their healthcare provider as medication adjustments may help. Some key interventions that may help reduce fatigue include:
- Physical activity, as data from small clinical trials indicate that it can reduce fatigue in patients with chronic kidney disease 1
- Aerobic exercise, which moderate-quality evidence from meta-analyses indicates can decrease depressive symptom burden in hemodialysis 1
- Psychological interventions, such as cognitive behavioral therapy, which have efficacy in reducing depression 1
- Manual acupressure, which limited evidence has indicated has short-term benefits as an adjuvant intervention for fatigue and depression 1.
It is essential to note that the exact incidence and prevalence of individual symptoms vary depending on patient population studied, and development of dialysis-related complications, highlighting the need for personalized approaches to managing post-dialysis fatigue 1.
From the Research
Causes of Fatigue in Dialysis Patients
- Fatigue in patients undergoing hemodialysis is a highly prevalent and debilitating symptom due to the uremic milieu, the hemodialysis treatment itself, and other comorbid conditions 2.
- The pathophysiology of postdialysis fatigue (PDF) is not well understood, but several hypotheses include inflammation, hypothalamic-pituitary-adrenal axis dysregulation, and osmotic and fluid shifts 3.
- Cardiovascular and hemodynamic effects of the dialysis procedure, laboratory abnormalities, depression, and physical inactivity are associated with PDF 3.
Impact of Fatigue on Dialysis Patients
- Fatigue drains vitality in patients and constrains their ability to do usual activities and fulfill their roles and meet personal aspirations 2.
- Fatigue has a considerable effect on patient health-related quality of life and is viewed as being more important than survival by some patients 4.
- Fatigue is associated with restricted life participation, including deprivation of time, managing energy reserves, and frustrating need to rest 2.
Recognition and Management of Fatigue
- Fatigue remains underrecognized and the consequences are underappreciated because it may not be visible in clinical settings 2.
- There is a need to enable renal health professionals to communicate about the complex nature of fatigue in renal patients and stimulate interdisciplinary exchange and shared responsibility 5.
- Dialysis nurses can play an important role in understanding the lived experiences of patients within their social contexts and addressing fatigue 5.
- Possible interventions for minimizing fatigue in patients on long-term dialysis therapy should aim at improving health care provider awareness, developing improved methods of measurement, understanding the pathogenesis better, and managing known contributing factors 4.