skip to main content

Factors Related to Fatigue among Chronic Kidney Disease Patients on Hemodialysis

*Fitri Mailani orcid scopus  -  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
Open Access Copyright (c) 2025 by the Authors, Published by Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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.

Methods: A cross-sectional study was conducted in two hemodialysis centers. 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 levels as the strongest predictors of fatigue.

Conclusion: Fatigue is a prevalent issue among 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, a healthy diet, and fluid adherence, alongside routine monitoring of hemoglobin levels, may help reduce fatigue and improve quality of life in this population.

Fulltext View|Download
Keywords: Chronic kidney disease; contributing factors; fatigue; hemodialysis

Article Metrics:

  1. 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. https://doi.org/10.9790/1959-0603016169
  2. Almutary, H., Bonner, A., & Douglas, C. (2016). Which patients with chronic kidney disease have the greatest symptom burden? A comparative study of advanced CKD stage and dialysis modality. Journal of Renal Care, 42(2), 73–82. https://doi.org/10.1111/jorc.12152
  3. Alshammari, B., Alkubati, S. A., Alrasheeday, A., Pasay-An, E., Edison, J. S., Madkhali, N., Al-Sadi, A. K., Altamimi, M. S., Alshammari, S. O., Alshammari, A. A., & Alshammari, F. (2024). Factors influencing fatigue among patients undergoing hemodialysis: a multicenter cross-sectional study. The Libyan Journal of Medicine, 19(1), 2301142. https://doi.org/10.1080/19932820.2023.2301142
  4. Al Naamani, Z., Gormley, K., Noble, H., Santin, O., & Al Maqbali, M. (2021). Fatigue, anxiety, depression and sleep quality in patients undergoing haemodialysis. BMC Nephrology, 22, 157. https://doi.org/10.1186/s12882-021-02349-3
  5. Álvarez, L., Brown, D., Hu, D., Chertow, G. M., Vassalotti, J. A., & Prichard, S. (2020). Intradialytic symptoms and recovery time in patients on thrice-weekly in-center hemodialysis: A cross-sectional online survey. Kidney Medicine, 2(2), 125–130. https://doi.org/10.1016/j.xkme.2019.10.010
  6. 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. https://doi.org/10.1111/j.1365-2702.2007.02042.x
  7. Burgos-Calderón, R., Depine, S. Á., & Aroca-Martínez, G. (2021). Population kidney health: A new paradigm for chronic kidney disease management. International Journal of Environmental Research and Public Health, 18(13), 6786. https://doi.org/10.3390/ijerph18136786
  8. 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
  9. Darmawan, I. P. E., Nurhesti, P. O., & Suardana, I. K. (2019). Hubungan lamanya menjalani hemodialisis dengan fatigue pada pasien chronic kidney disease [The relationship between duration of hemodialysis and fatigue in patients with chronic kidney disease]. Community of Publishing in Nursing (COPING), 7(3), 139–146. https://ojs.unud.ac.id/index.php/coping/article/view/55793
  10. Davey, C. H., Webel, A. R., Sehgal, A. R., Voss, J. G., & Huml, A. (2019). Fatigue in individuals with end stage renal disease. Nephrology Nursing Journal: Journal of the American Nephrology Nurses’ Association, 46(5), 497–508
  11. Farragher, J. F., Polkinghorne, K. R., & Kerr, P. G. (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), e030333. https://doi.org/10.1136/bmjopen-2019-030333
  12. 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), 236–242. https://doi.org/10.5527/wjn.v6.i5.236
  13. Hasan, M. N., & Tirtana, A. (2019). Relationship between biochemical marker and comorbidity with fatigue in patients with hemodialisis in Yogyakarta. Jurnal Kesehatan Madani Medika, 10(2), 115–122. https://doi.org/10.36569/jmm.v10i2.80
  14. Hosmer Jr, D. W., Lemeshow, S., & Sturdivant, R. X. (2013). Applied logistic regression. John Wiley & Sons
  15. Jhamb, M., Liang, K., Yabes, J., Steel, J. L., Dew, M. A., Shah, N., & Unruh, M. (2013). Prevalence and correlates of fatigue in CKD and ESRD: Are sleep disorders a key to understanding fatigue? American Journal of Nephrology, 38(6), 489–495. https://doi.org/10.1159/000356241
  16. Joshwa, B., Peters, R. M., Malek, M. H., Yarandi, H. N., & Campbell, M. L. (2020). Multiple dimensions and correlates of fatigue in individuals on hemodialysis. Nephrology Nursing Journal, 47, 3. https://doi.org/10.37526/1526-744X.2020.47.3.215
  17. Laksamana, A. A., & Indriyawati, N. (2022). Fatigue level of chronic kidney failure patients after undergoing hemodialysis therapy. Jurnal Keperawatan Global, 7(1), 29-42. https://doi.org/10.37341/jkg.v0i0.498
  18. Maesaroh, M., Waluyo, A., & Jumaiyah, W. (2020). Faktor-faktor yang berhubungan dengan terjadinya fatigue pada pasien hemodialisis [Factors associated with the occurrence of fatigue in hemodialysis patients]. Syntax Literate: Jurnal Ilmiah Indonesia, 5(4), 110–120. https://doi.org/10.36418/syntax-literate.v5i4.1074
  19. Mailani, F., Herien, Y., Muthia, R., Tumanggor, R. D., & Huriani, E. (2022). The experiences of patients with chronic kidney disease undergoing dialysis in managing the symptoms. Malaysian Journal of Medicine and Health Sciences, 18(Suppl. 18), 42–50
  20. Mailani, F., Febriyana, I., Rahman, D., Sarfika, R., & Mulyanti, R. M. (2024). Good health literacy leads to better quality of life and medication adherence among hemodialysis patients. Jurnal Ners, 19(1), 103–110. http://dx.doi.org/10.20473/jn.v19i1.49247
  21. 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
  22. Mardiyah, A., & Azmy, R. A. (2022). Level of fatigue in chronic kidney disease patients undergoing hemodialysis. Journal of Applied Nursing and Health, 4(1), 116–121. https://doi.org/10.55018/janh.v4i1.64
  23. Mayer, C. C., Matschkal, J., Sarafidis, P. A., Hagmair, S., Lorenz, G., Angermann, S., Braunisch, M. C., 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
  24. Merdawati, L., Lin, H. C., Wang, Y. C., Lin, K. C., & Huang, H. C. (2024). Factors associated with loneliness in middle-aged and older patients with breast cancer. Asia-Pacific Journal of Oncology Nursing, 11(5), 100444. https://doi.org/10.1016/j.apjon.2024.100444
  25. Muliantino, R. M., Qadri, N. Z., Afriyanti, E., & Sarfika, R. (2024). Self-efficacy in increasing physical activity of coronary heart disease patients: A cross-sectional study. Jurnal Ners, 19(3), 371–378. http://dx.doi.org/10.20473/jn.v19i3.51941
  26. Nasriyanto, E. N. (2018). Pengaruh determinan sosial terhadap tingkat literasi kesehatan pada mahasiswa Universitas Indonesia di Kota Depok [The influence of social determinants on the level of health literacy among students at the University of Indonesia in Depok City] [Unpublished master’s thesis, Universitas Indonesia]. Universitas Indonesia Repository. https://lib.fkm.ui.ac.id/detail?id=130935&lokasi=lokal
  27. Nurtandhee, M. (2023). Estimasi biaya pelayanan kesehatan sebagai upaya pencegahan defisit dana jaminan sosial untuk penyakit gagal ginjal [Estimation of health service costs as an effort to prevent a deficit in social security funds for kidney failure]. Jurnal Jaminan Kesehatan Nasional, 3(2), 84–101. https://doi.org/10.53756/jjkn.v3i2.104
  28. Pelikan, J. M., Röthlin, F., & Ganahl, K. (2019). Measuring health literacy in Europe: Introducing the European health literacy survey questionnaire (HLS-EU-Q). In O. Okan, U. Bauer, D. Levin-Zamir, P. Pinheiro, & K. Sørensen (Eds.), International handbook of health literacy (pp. 115–138). Policy Press. https://doi.org/10.51952/9781447344520.ch008
  29. Parker Gregg, L., Bossola, M., Ostrosky-Frid, M., & 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
  30. Polit, D. F., & Beck, C. T. (2014). Study guide for essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins
  31. 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
  32. Ritianingsih, N., Nawati, N., & 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), 319–326. https://doi.org/10.37287/ijghr.v5i2.1703
  33. Santoso, D., Sawiji, S., Oktantri, H., & Septiwi, C. (2022). Faktor-faktor yang berhubungan dengan fatigue pada pasien gagal ginjal kronik yang menjalani hemodialisa di RSUD Dr. Soedirman Kebumen [Factors related to fatigue in chronic kidney failure patients undergoing hemodialysis at Dr. Soedirman Regional Hospital, Kebumen]. Jurnal Ilmiah Kesehatan Keperawatan, 18(1), 60. https://doi.org/10.26753/jikk.v18i1.799
  34. 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, e86514. https://doi.org/10.1371/journal.pone.0086514
  35. 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
  36. Tian, C., Zhang, B., Liang, W., Yang, Q., Xiong, Q., Jin, Q., Xiang, S., Zhao, J., Ying, C., & 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.e2. https://doi.org/10.1016/j.jpainsymman.2019.12.351
  37. 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), e22994. https://doi.org/10.7759/cureus.22994
  38. 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
  39. 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 multicenter cross-sectional study. Renal Failure, 38(3), 442–450. https://doi.org/10.3109/0886022X.2016.1138819
  40. World Health Organization. (2020). The top 10 causes of death. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
  41. Van der Borg, W. E., Verdonk, P., de Jong-Camerik, J., & Abma, T. A. (2021). How to relate to dialysis patients’ fatigue–Perspectives of dialysis nurses and renal health professionals: A qualitative study. International Journal of Nursing Studies, 117, 103884. https://doi.org/10.1016/j.ijnurstu.2021.103884

Last update:

No citation recorded.

Last update: 2025-07-24 05:49:08

No citation recorded.