Fatigue in chronic peritoneal dialysis patients

Fatigue is a common complaint in long term dialysis patients that may influence their quality of life. The present study was carried out in order to evaluate the prevalence and course of fatigue in a group of chronic PD patients and to find the possible factor(s) related to its development. We retrospectively reviewed 100 charts of the patients previously on PD. The presence or absence of fatigue in the 1st and last clinic visits and the 1st and 2nd changes in fatigue state were studied according to the monthly clinical records of the primary nurses. Data regarding dialysate volume, urine volume, weekly erythropoietin (EPO) dose, hemoglobin, hematocrit, blood urea, serum creatinine, residual renal creatinine and urea clearances, dialysate to peritoneal creatinine ratio (D/P Cr), total weekly Kt/V and total creatinine clearance/1.73 m2 body surface area (TCrCl) were collected. Fifty-five patients were male and 45 female. The mean age at the 1st clinic visit was 61.3 +/- 16 years. At the 1st visit 55 patients had fatigue and 45 did not. In 32 of the 55 patients fatigue disappeared after a mean duration of 7.9 +/- 8.4 months and in 31 of the 45 patients fatigue appeared after a mean duration of 8 +/- 6.8 months. So at the last visit the frequency of fatigue increased significantly from 55% to 67% (p < 0.001). In patients with fatigue the mean age and female percentage were higher (64.2 +/- 14.1 vs 57.8 +/- 17.6, p = 0.05 and 1.2 vs 0.5, p < 0.05 respectively), mean hemoglobin concentration was lower (104.4 +/- 14.7 vs 110.6 +/- 14.2 g/L, p < 0.04) and mean EPO dose was higher (6379.6 +/- 7142 vs 3395.4 +/- 4337.8 units/week, p < 0.02) at the 1st clinic visit. EPO dose was also higher in patients with fatigue at the last visit (8253.7 +/- 10317.3 units/wk vs 4736.4 +/- 5432.5, p < 0.03). No correlation was found between dialysis adequacy according to either weekly Kt/V or TCrCl and nutritional state according to nPCR and frequency of fatigue. We conclude that fatigue is a common symptom in PD patients and it's prevalence increases over time. Anemia seems to be the most important factor associated with fatigue. Dialysis adequacy and nutritional state did not show any correlation with the frequency of fatigue in our study.