title: Fatigue is a predictor for cardiovascular outcomes in patients undergoing hemodialysis.
abstract: OBJECTIVE
  Despite potential significance of fatigue and its underlying components in the occurrence of cardiovascular diseases, epidemiologic data showing the link are virtually limited. This study was designed to examine whether fatigue symptoms or fatigue's underlying components are a predictor for cardiovascular diseases in high-risk subjects with ESRD.
  
  
  METHODS
  788 volunteer patients under hemodialysis therapy (506 male, 282 female) completed the survey between October and November 2005, with the follow-up period up to 26 months to monitor occurrence of fatal or nonfatal cardiovascular events. The questionnaire consisted of 64 questions, and promax rotation analysis of the principal component method conceptualized eight fatigue-related factors: fatigue itself, anxiety and depression, loss of attention and memory, pain, overwork, autonomic imbalance, sleep problems, and infection.
  
  
  RESULTS
  14.7% of the patients showed fatigue scores higher than twice the SD of the mean for healthy volunteers. These highly fatigued patients exhibited a significantly higher risk for cardiovascular events (hazard ratio: 2.17; P < 0.01), with the relationship independent of the well-known risk factors, including age, diabetes, cardiovascular disease history, and inflammation and malnutrition markers. Moreover, comparisons of the risk in key subgroups showed that the risk of high fatigue score for cardiovascular events was more prominent in well-nourished patients, including lower age, absence of past cardiovascular diseases, higher serum albumin, and high non-HDL cholesterol.
  
  
  CONCLUSIONS
  Fatigue can be an important predictor for cardiovascular events in patients with ESRD, with the relationship independent of the nutritional or inflammatory status.
authors.affiliation: Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. hidekoyama@med.osaka-cu.ac.jp
authors.forename: Hidenori
authors.initials: H
authors.lastname: Koyama
authors.forename: Sanae
authors.initials: S
authors.lastname: Fukuda
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.forename: Masaaki
authors.initials: M
authors.lastname: Inaba
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tsujimoto
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tabata
authors.forename: Senji
authors.initials: S
authors.lastname: Okuno
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamakawa
authors.forename: Shigeki
authors.initials: S
authors.lastname: Okada
authors.forename: Mikio
authors.initials: M
authors.lastname: Okamura
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Kuratsune
authors.forename: Hisako
authors.initials: H
authors.lastname: Fujii
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Hirayama
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D016022:Case-Control Studies; D005221:Fatigue / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D025341:Principal Component Analysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors