Association Between Postdialysis Fatigue and Number of Comorbidities and Number and Prevalence of Symptoms

To investigate the association between postdialysis fatigue (PDF) and physical and emotional symptoms in patients receiving maintenance hemodialysis.

All prevalent patients undergoing maintenance hemodialysis at our Hemodialysis Service between June 2022 and September 2024 were considered eligible. The Dialysis Symptom Index questionnaire was administered during dialysis sessions. PDF was assessed using the approach recommended by Sklar et al. Patients were classified as having PDF if they spontaneously reported feeling fatigued after dialysis in response to the question: "Do you feel fatigued after dialysis?"

A total of 269 patients were studied: 220 with PDF and 49 without. Patients with PDF were significantly older and had a higher Charlson comorbidity index. The median [95% CI] number of symptoms was 13 [12-14] in patients with PDF versus 7 [6-8.8] in those without (p < 0.0001). In multivariable logistic regression, PDF was independently associated with the Charlson comorbidity index (odds ratio [95% CI]: 1.41 [1.08-1.85], p = 0.010) and the total number of symptoms (1.27 [1.16-1.40], p < 0.0001). The prevalence of 15 out of 29 symptoms was significantly higher in patients with PDF. After adjustment, PDF remained independently associated with swelling in the legs (OR [95% CI]: 12.8 [1.43-113.9], p = 0.022), restless legs (3.41 [0.98-11.8], p = 0.052), difficulty concentrating (8.24 [2.12-32.1], p = 0.002), difficulty becoming sexually aroused (6.00 [2.58-13.9], p < 0.0001), and feeling sad (6.06 [2.31-15.9], p = 0.0003). The severity of itching, bone or joint pain, worrying, feeling nervous, feeling anxious, and decreased interest in sex was also significantly greater in patients with PDF.

PDF is independently associated with a higher burden of comorbidities and a greater number of physical and emotional symptoms. It is also specifically linked to the prevalence of leg swelling, restless legs, difficulty concentrating, difficulty becoming sexually aroused, and sadness.