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Energy conservation education intervention for people with end-stage kidney disease receiving haemodialysis
Sita Sharma1, Kimberly E Alexander2, Theresa Green3
1School of Nursing and Midwifery and Griffith Health, Griffith University, Nathan, Australia; School of Nursing and Midwifery and Centre for Health Research, University of Southern Queensland, Ipswich, Australia.
Background:
Fatigue is a common symptom in kidney failure and impacts on health-related quality of life. Educational interventions involving energy conservation strategies have effectively reduced fatigue in people with other chronic diseases.
Objective:
To evaluate the effectiveness of an energy conservation education intervention for people with kidney failure receiving haemodialysis (EVEREST).
Design:
A two-arm parallel group study with haemodialysis shift randomisation.
Methods:
Recruitment commenced in April 2022 and included 126 participants receiving haemodialysis who met the eligibility criteria. They were randomised based on haemodialysis shifts. The intervention group received a structured energy conservation education program plus usual care over 12 weeks. The control group received the usual care. The energy conservation education program consisted of three individual face-to-face educational sessions, one booster session, and a booklet. Outcomes were fatigue, other chronic kidney disease (CKD) symptoms, occupational performance, and health-related quality of life. Data were collected at baseline, week 4, week 8, and week 12. Intention-to-treat analysis was used.
Results:
Participants who received the energy conservation education program showed a significant reduction in fatigue severity (mean difference [MD] = -1.88, 95 % confidence intervals [CI] [-2.36 to -1.40], p < .001), fatigue interference (MD = -1.52, 95 % CI [-2.02 to -1.02], p < .001), number of fatigue days (MD = -1.12, 95 % CI [-1.60 to -0.64], p < .001), and percent of day fatigued (MD = -18.47, 95 % CI [-23.60 to -13.34], p < .001) at week 8 compared to the control group. At week 12, medium to large effect sizes for fatigue severity (effect size [ES] = 2.37, p < .001), fatigue interference (ES = 1.68, p < .001), number of fatigue days (ES = 0.74, p < .001), and percent of day fatigued (ES = 2.10, p < .001) were observed in the intervention group compared to the control group. Similarly, significant improvements were detected in the CKD symptom (ES = 1.49, p < .001), occupational performance (ES = 1.17, p < .001), and satisfaction with the performance (ES = 1.59, p < .001) in the intervention group compared to the control group. A significant effect was seen for health-related quality of life in the intervention group [physical health (ES = 2.14, p < .001) and mental health (ES = 2.06, p < .001)] at week 12 compared to the control group.
Conclusions:
The energy conservation education program was successful in reducing fatigue in the haemodialysis population. This simple approach enabled individuals to improve everyday activities, reduce other CKD symptoms and improve health-related quality of life. Nurses could incorporate the energy conservation education program into routine practice in haemodialysis units.
Registration:
The trial was registered in ClinicalTrials.gov (Trial registration ID NCT04360408) on April 23, 2020.
Tweetable Abstract:
Educational intervention about energy conservation for those on haemodialysis reduced fatigue and improved daily activities and health-related quality of life.
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