Extracellular Water Excess and Increased Self-Reported Fatigue in Chronic Hemodialysis Patients

Hemodialysis patients (HD) commonly report fatigue. Muscle wasting (sarcopenia) and extracellular water (ECW) excess have been reported to be associated with fatigue in other conditions. We wished to determine whether muscle loss and ECW excess were associated with fatigue in HD patients. Patients completed the Multidimensional Fatigue Inventory (MFI), Beck Depression Inventory-II (BDI-II), Patient Health Questionnaires (PHQ-9) and recorded their post-dialysis recovery time. Sessional dialysis data were recorded along with pre- and post-dialysis multi-frequency bioimpedance assessments (MFBIA). One hundred and ten patients, median age 64 (52-79) years, 67% male, 35% diabetic completed questionnaires and had pre- and post-HD MFBIAs. Median total MFI score was 60 (48-72), with the physical domain having the highest score. Modal (30.8%) recovery time post-dialysis was 1-4h. Of the participants, 35% and 34% had increased BDI-II and PHQ-9 scores, respectively. Total MFI score was associated with increased BDI-II (>16) (standardized (Std) 0.54, P<0.001), PHQ-9 (>10) scores (Std 0.49, P<0.001, past history of depression (Std 0.28, P=0.003), post-HD ECW/total body water ratio (Std 0.25, P=0.002), recovery time>8h (Std 0.26, P=0.001), post dialysis mean arterial pressure (MAP) (Std -0.19, P=0.02), and muscle wasting (Std -0.15, P=0.05). Self-reported fatigue in HD patients is associated with self-reported depression, but also dialysis-related factors including increased ECW post HD, low MAP, and longer recovery times. Patients with reduced muscle mass were less likely to report fatigue, possibly accepting physical limitations. As such, interventions to reduce fluid overload and improve dialysis experience may help improve fatigue.