Identification of factors responsible for postdialysis fatigue.
Ultrafiltration, diffusion, osmotic shifts, blood-membrane interactions, and psychological factors have all been implicated in the pathogenesis of postdialysis fatigue (PDF). To identify responsible factors, we performed a prospective, randomized, crossover analysis of fatigue scores (scale, 0 to 4) in 12 maintenance hemodialysis subjects with PDF. Fatigue scores were evaluated on nondialysis days (baseline) and after the following procedures on midweek treatment days: standard dialysis using either a 135- to 140-mEq/L sodium bath (routine hemodialysis) or a 150- to 155-mEq/L sodium bath (hypernatric hemodialysis); isolated ultrafiltration; isolated diffusion; and sham procedures with (isolated membrane) or without (recirculation) exposure to a dialysis membrane. Maximal fatigue scores are expressed as mean and 95% confidence intervals (CIs). The highest scores were recorded by patients who had just undergone routine hemodialysis (mean score, 2. 6; 95% CI, 1.7 to 3.4), isolated ultrafiltration (mean score, 2.1; 95% CI, 1.3 to 2.9), and isolated diffusion (mean score, 2.4; 95% CI, 1.5 to 3.2). There were no significant differences in fatigue scores between baseline periods and isolated membrane and recirculation procedures (mean score, 1.3; 95% CI, 0.4 to 2.2). Fatigue scores after hypernatric hemodialysis occupied an intermediate position (mean score, 1.7; 95% CI, 0.8 to 2.6). These results suggest that rapid hydraulic and molecular flux have a greater role in the pathogenesis of PDF than psychological stress and blood-membrane interactions. Use of a high-sodium bath may ameliorate PDF. We conclude that appropriate adjustments in both ultrafiltration and sodium profiling remain the most important means for controlling PDF in patients on short-duration hemodialysis.
Sklar
A
A
Nutrition, United Health Services Hospitals, Binghamton, NY, USA. asklar@juno.com
Newman
N
N
Scott
R
R
Semenyuk
L
L
Schultz
J
J
Fiacco
V
V
D018592:Cross-Over Studies; D004058:Diffusion; D005221:Fatigue / Q000209:etiology* / Q000517:prevention & control; D017583:Hemodiafiltration; D015312:Hemodialysis Solutions / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D012964:Sodium / Q000097:blood; D013315:Stress, Psychological / Q000150:complications
D015312:Hemodialysis Solutions; D008567:Membranes, Artificial; D012964:Sodium