Factors Related to Fatigue among Chronic Kidney Disease Patients on Hemodialysis

Fitri Mailani; Arif Rohman Mansur; Aisyah Rifdatunnisa; Chong Mei Chan

doi:10.14710/nmjn.v15i1.59980

DOI: https://doi.org/10.14710/nmjn.v15i1.59980

Factors Related to Fatigue among Chronic Kidney Disease Patients on Hemodialysis

*Fitri Mailani

- Faculty of Nursing, Universitas Andalas, Indonesia

Arif Rohman Mansur - Faculty of Nursing, Universitas Andalas, Indonesia

Aisyah Rifdatunnisa - Faculty of Nursing, Universitas Andalas, Indonesia

Chong Mei Chan - Department of Nursing Science, Faculty of Medicine, University of Malaya, Malaysia

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

BibTex Citation Data :

@article{NMJN59980,
    author = {Fitri Mailani and Arif Mansur and Aisyah Rifdatunnisa and Chong Chan},
    title = {Factors Related to Fatigue among Chronic Kidney Disease Patients on Hemodialysis},
    journal = {Nurse Media Journal of Nursing},
  volume = {15},
    number = {1},
    year = {2025},
    keywords = {Chronic kidney disease; contributing factors; fatigue; hemodialysis},
    abstract = {  Background:  Fatigue is a common and distressing symptom among patients with chronic kidney disease (CKD) undergoing hemodialysis, significantly impacting their daily functioning and quality of life. Despite its prevalence, the contributing factors to fatigue remain unclear and underexplored in specific populations.   Purpose:  This study aimed to identify factors associated with fatigue among CKD patients undergoing hemodialysis in Padang, Indonesia.   Methods:  A cross-sectional study was conducted in two hemodialysis centers in Padang between June and July 2023. A total of 164 patients were recruited using convenience sampling, with sample size determined through power analysis. Data were collected using the FACIT-Fatigue Scale, a health literacy questionnaire, and an observation sheet for hemoglobin (Hb), blood pressure, and interdialytic weight gain (IDWG). Patient characteristics were also recorded. T-tests and ANOVA were used to examine differences in fatigue levels across groups, while Spearman correlation and multiple linear regression were employed to analyze associations between fatigue and clinical variables.   Results:  The mean fatigue score was 28.23 (SD = 7.46). Fatigue was significantly associated with age, education level, employment status, comorbidities, duration of hemodialysis, systolic blood pressure, Hb, IDWG, and health literacy (p < 0.05). Multiple linear regression identified employment status and hemoglobin level as the strongest predictors of fatigue, accounting for 27.8% and 23.9% of the variance, respectively.   Conclusion:  Fatigue is a prevalent issue in CKD patients undergoing hemodialysis and is influenced by a range of demographic, clinical, and behavioral factors. Employment status and hemoglobin levels were the most significant contributors. Interventions promoting physical activity, diet, and fluid adherence, alongside routine monitoring of Hb, may help reduce fatigue and improve quality of life in this population. },
   issn = {2406-8799},  doi = {10.14710/nmjn.v15i1.59980},
    url = {https://ejournal.undip.ac.id/index.php/medianers/article/view/59980}
}

Citation Format:

Abstract

Background: Fatigue is a common and distressing symptom among patients with chronic kidney disease (CKD) undergoing hemodialysis, significantly impacting their daily functioning and quality of life. Despite its prevalence, the contributing factors to fatigue remain unclear and underexplored in specific populations.

Purpose: This study aimed to identify factors associated with fatigue among CKD patients undergoing hemodialysis in Padang, Indonesia.

Methods: A cross-sectional study was conducted in two hemodialysis centers in Padang between June and July 2023. A total of 164 patients were recruited using convenience sampling, with sample size determined through power analysis. Data were collected using the FACIT-Fatigue Scale, a health literacy questionnaire, and an observation sheet for hemoglobin (Hb), blood pressure, and interdialytic weight gain (IDWG). Patient characteristics were also recorded. T-tests and ANOVA were used to examine differences in fatigue levels across groups, while Spearman correlation and multiple linear regression were employed to analyze associations between fatigue and clinical variables.

Results: The mean fatigue score was 28.23 (SD = 7.46). Fatigue was significantly associated with age, education level, employment status, comorbidities, duration of hemodialysis, systolic blood pressure, Hb, IDWG, and health literacy (p < 0.05). Multiple linear regression identified employment status and hemoglobin level as the strongest predictors of fatigue, accounting for 27.8% and 23.9% of the variance, respectively.

Conclusion: Fatigue is a prevalent issue in CKD patients undergoing hemodialysis and is influenced by a range of demographic, clinical, and behavioral factors. Employment status and hemoglobin levels were the most significant contributors. Interventions promoting physical activity, diet, and fluid adherence, alongside routine monitoring of Hb, may help reduce fatigue and improve quality of life in this population.

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Keywords: Chronic kidney disease; contributing factors; fatigue; hemodialysis

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In Vol 15, No 1 (2025): (April 2025) (in progress)

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Ali, H. H., & Taha, N. M. (2017). Fatigue, depression and sleep disturbance among hemodialysis patients. IOSR Journal of Nursing and Health Science, 6(3), 61-69. 10.9790/1959-0603016169
Al Naamani, Z., Gormley, K., Noble, H., Santin, O., & Al Maqbali, M. (2021a). Fatigue, anxiety, depression and sleep quality in patients undergoing haemodialysis. BMC Nephrology, 22(1). https://doi.org/10.1186/s12882-021-02349-3
Al Naamani, Z., Gormley, K., Noble, H., Santin, O., & Al Maqbali, M. (2021b). Fatigue, anxiety, depression and sleep quality in patients undergoing haemodialysis. BMC Nephrology, 22(1). https://doi.org/10.1186/s12882-021-02349-3
Bonner, A., Wellard, S., & Caltabiano, M. (2008). Levels of fatigue in people with ESRD living in far North Queensland. Journal of clinical nursing, 17(1), 90-98. doi: 10.1111/j.1365-2702.2007.02042.x
Burdelis, R. E. M., & Cruz, F. J. S. M. (2023). Prevalence and predisposing factors for fatigue in patients with chronic renal disease undergoing hemodialysis: a cross-sectional study. Sao Paulo Medical Journal, 141, e2022127. https://doi.org/10.1590/1516-3180.2022.0127.R1.01122022
Burgos-Calderón, R., Depine, S. Á., & Aroca-Martínez, G. (2021). Population kidney health. A new paradigm for chronic kidney disease management. In International Journal of Environmental Research and Public Health (Vol. 18, Issue 13). MDPI AG. https://doi.org/10.3390/ijerph18136786
Brys, A., Lenaert, B., Heugten, C., Gambaro, G., & Bossola, M. (2019). Exploring the Diurnal Course of Fatigue in Patients on Hemodialysis Treatment and Its Relation With Depressive Symptoms and Classical Conditioning. Journal of pain and symptom management, 57 5, 890-898.e4. https://doi.org/10.1016/j.jpainsymman.2019.02.010
Farragher, J. F. et al. (2019). Protocol for a pilot randomised controlled trial of an educational programme for adults on chronic haemodialysis with fatigue (Fatigue-HD). BMJ Open, 9(7). doi: 10.1136/bmjopen-2019-030333
Fateh, H. R. et al. (2022). The effect of energy conservation strategies on fatigue, function, and quality of life in adults with motor neuron disease: Randomized controlled trial. Current Journal of Neurology, 21(2), pp. 83–90. doi: 10.18502/cjn.v21i2.10491
Giannaki, C. D., Hadjigavriel, M., Lazarou, A., Michael, A., Damianou, L., Atmatzidis, E., Stefanidis, I., Hadjigeorgiou, G. M., Sakkas, G. K., & Pantzaris, M. (2017). Restless legs syndrome is contributing to fatigue and low quality of life levels in hemodialysis patients. World Journal of Nephrology, 6(5), 236. https://doi.org/10.5527/wjn.v6.i5.236
Horigan, A. E. (2012). Fatigue in hemodialysis patients: A review of current knowledge. In Journal of Pain and Symptom Management (Vol. 44, Issue 5, pp. 715–724). https://doi.org/10.1016/j.jpainsymman.2011.10.015
Jhamb, M., Argyropoulos, C., Steel, J., Plantinga, L., Wu, A., Fink, N., Powe, N., Meyer, K., & Unruh, M. (2009). Correlates and outcomes of fatigue among incident dialysis patients. Clinical journal of the American Society of Nephrology : CJASN, 4 11, 1779-86. https://doi.org/10.2215/CJN.00190109
IRR. (2018). 11th report Of Indonesian renal registry 2018. Indonesian Renal Registry (IRR), 14–15
Jacobson, J., Ju, A., Baumgart, A., Unruh, M., O'Donoghue, D., Obrador, G., Craig, J., Dapueto, J., Dew, M., Germain, M., Fluck, R., Davison, S., Jassal, S., Manera, K., Smith, A., & Tong, A. (2019). Patient Perspectives on the Meaning and Impact of Fatigue in Hemodialysis: A Systematic Review and Thematic Analysis of Qualitative Studies. American journal of kidney diseases, the journal of the National Kidney Foundation. https://doi.org/10.1053/j.ajkd.2019.01.034
Jhamb, M., Weisbord, S. D., Steel, J. L., & Unruh, M. (2008). Fatigue in Patients Receiving Maintenance Dialysis: A Review of Definitions, Measures, and Contributing Factors. In American Journal of Kidney Diseases (Vol. 52, Issue 2, pp. 353–365). https://doi.org/10.1053/j.ajkd.2008.05.005
Joshwa, B., Khakha, D. C., & Mahajan, S. (2012). Fatigue and Depression and Sleep Problems among Hemodialysis Patients in a Tertiary Care Center. In Saudi J Kidney Dis Transpl (Vol. 23, Issue 4). http://journals.lww.com/sjkd
Kodama, H., Togari, T., Konno, Y., Tsuji, A., Fujinoki, A., Kuwabara, S., & Inoue, T. (2020). A new assessment scale for post-dialysis fatigue in hemodialysis patients. Renal Replacement Therapy, 6(1), 4–11. https://doi.org/10.1186/s41100-019-0252-5
Koyama H, Fukuda S, Shoji T, et al. (2010). Fatigue is a predictor for cardiovascular outcomes in patients undergoing hemodialysis. Clin J Am Soc Nephrol, 5(4):659–666
Laksamana, A. A., & Indriyawati, N. (2022). Fatigue level of chronic kidney failure patients after undergoing hemodialysis therapy.pdf. Jurnal Keperawatan Global, 7(1). Retrieved from doi.or/10.37341/jkg.v0i0.498
Maesaroh, M., Waluyo, A., & Jumaiyah, W. (2020). Faktor-faktor yang berhubungan dengan terjadinya Fatigue pada pasien Hemodialisis. Syntax Literate; Jurnal Ilmiah Indonesia, 5(4), 110-120
Mailani, F., Herien, Y., Muthia, R., Tumanggor, R. D., & Huriani, E. (2022a). The experiences of patients with chronic kidney disease undergoing dialysis in managing the symptoms. Malaysian Journal of Medicine and Health Sciences, 18(SUPP18): 42-50
Mailani, F., Huriani, E., Muthia, R., & Rahmiwati, R. (2023). Self-management and relating factors among chronic kidney disease patients on hemodialysis: An Indonesian study. Nurse Media Journal of Nursing, 13(1), 109-120. https://doi.org/10.14710/nmjn.v13i1.48708
Mardiyah, A., & Azmy, R. A. (2022). Level fatigue of chronic kidney disease patients undergoing hemodialysis. Journal of Applied Nursing and Health, 4(1), 116–121. https://doi.org/10.55018/janh.v4i1.64
Mayer, C., Matschkal, J., Sarafidis, P., Hagmair, S., Lorenz, G., Angermann, S., Braunisch, M., Baumann, M., Heemann, U., Wassertheurer, S., & Schmaderer, C. (2018). Association of Ambulatory Blood Pressure with All-Cause and Cardiovascular Mortality in Hemodialysis Patients: Effects of Heart Failure and Atrial Fibrillation. Journal of the American Society of Nephrology : JASN, 29 9, 2409-2417. https://doi.org/10.1681/ASN.2018010086
Nasriyanto, E. N. (2018). Pengaruh Determinan Sosial Terhadap Tingkat Literasi Kesehatan Pada Mahasiswa Universitas Indonesia di Kota Depok. (Unpublished master thsis). Repositori Universitas Indonesia
Pelikan, J. M. et al. (2019). Measuring health literacy in Europe: Introducing the European Health Literacy Survey Questionnaire (HLS-EU-Q). In International handbook of health literacy (pp. 115–138). Policy Press. https://doi.org/https://doi.org/10.51952/9781447344520.ch008
Parker Gregg, L., Bossola, M., Ostrosky-Frid, M., & Susan Hedayati, S. (2021). Fatigue in ckd epidemiology, pathophysiology, and treatment. Clinical Journal of the American Society of Nephrology, 16(9), 1445–1455. https://doi.org/10.2215/CJN.19891220
Polit, D. F., & Beck, C. T. (2008). Nursing: Generating and assessing evidence for nursing practice. Lippincott Williams & Wilkins
Prastiwi, F., Wihastuti, T. A., & Ismail, D. D. S. L. (2022). Correlational analysis of physiological and psychological factors with fatigue on chronic kidney disease patients undergoing hemodialysis. Jurnal Aisyah : Jurnal Ilmu Kesehatan, 7(1), 85–92. https://doi.org/10.30604/jika.v7i1.803
Ritianingsih, N., Nawati, N. and Nurhayati, F. (2023). The Energy Conservation Strategies Can Improve Self Care Management of Chronic Kidney Disease Patients with Hemodialysis. Indonesian Journal of Global Health Research, 5(2), pp. 319–326. doi: 10.37287/ijghr.v5i2.1703
Selvarajah, V., Pasea, L., Ojha, S., Wilkinson, I., & Tomlinson, L. (2014). Pre-Dialysis Systolic Blood Pressure-Variability Is Independently Associated with All-Cause Mortality in Incident Haemodialysis Patients. PLoS ONE, 9. https://doi.org/10.1371/journal.pone.0086514
Sihombing, J. P., Hakim, L., Andayani, T. M., & Irijanto, F. (2016). Validation of Indonesian Version of FACIT Fatigue Scale Questionnaire in Chronic Kidney Disease (CKD) Patients with Routine Hemodialysis. Indonesian Journal of Clinical Pharmacy, 5(4), 231–237. https://doi.org/10.15416/ijcp.2016.5.4.231
Tian, C., Zhang, B., Liang, W., Yang, Q., Xiong, Q., Jin, Q., ... & Zuo, X. (2020). Fatigue in peritoneal dialysis patients and an exploration of contributing factors: a cross-sectional study. Journal of Pain and Symptom Management, 59(5), 1074-1081
Tsirigotis, S., Polikandrioti, M., Alikari, V., Dousis, E., Koutelekos, I., Toulia, G., Gerogianni, G. (2022). Factors associated with fatigue in patients undergoing hemodialysis. Cureus, 14(3), 1–18. https://doi.org/10.7759/cureus.22994
You, Q., Bai, D., Wu, C., Chen, H., Hou, C., Gao, J. (2022). Prevalence and Risk Factors of Postdialysis Fatigue in Patients Under Maintenance Hemodialysis: A Systematic Review and Meta-Analysis. Asian Nursing Research, 16(5), 292-298. https://doi.org/10.1016/j.anr.2022.11.002
Wang, S. Y., Zang, X. Y., Fu, S. H., Bai, J., Liu, J. D., Tian, L., Feng, Y. Y., & Zhao, Y. (2016). Factors related to fatigue in Chinese patients with end-stage renal disease receiving maintenance hemodialysis: A multi-center cross-sectional study. Renal Failure, 38(3), 442–450. https://doi.org/10.3109/0886022X.2016.1138819
WHO. (2020). The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death, on 14th April 2022

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Factors Related to Fatigue among Chronic Kidney Disease Patients on Hemodialysis

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