title: Impact of fatigue on outcomes in the hemodialysis (HEMO) study.
abstract: BACKGROUND
  Fatigue is a common debilitating symptom in chronic kidney disease patients on maintenance hemodialysis. However, little is known about its pathogenesis and association with survival.
  
  
  METHODS
  This study examines the correlates and outcomes of fatigue among 1,798 hemodialysis patients enrolled in the HEMO study. Fatigue was assessed using the SF-36 vitality scale. Multivariable analysis was used to assess independent associations of demographic and clinical characteristics with baseline fatigue and longitudinal changes in fatigue. The association of fatigue with all-cause and cause-specific mortality and cardiac hospitalizations was also assessed.
  
  
  RESULTS
  Higher index of coexistent diseases (ICED) score, diabetes, non-African-American race, lower serum albumin, use of medications for sleep and poor sleep quality were found to be significantly associated with more fatigue at baseline. In longitudinal analyses, patients who were older, had been on dialysis longer, had higher ICED score, and reported using medications for sleep were more likely to experience worsening fatigue, whereas higher serum albumin was strongly associated with an improvement in level of fatigue. A 10-point increase in vitality score was associated with 10% increase in mean survival (p < 0.0001).
  
  
  CONCLUSIONS
  Demographic and clinical factors have significant associations with fatigue, which itself predicts mortality. Improving fatigue in the end-stage renal disease population may positively impact patient well-being and survival.
authors.affiliation: Renal-Electrolyte Division, University of Pittsburgh Medical Center, PA, USA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Jhamb
authors.forename: Francis
authors.initials: F
authors.lastname: Pike
authors.forename: Sarah
authors.initials: S
authors.lastname: Ramer
authors.forename: Christos
authors.initials: C
authors.lastname: Argyropoulos
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steel
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Steven D
authors.initials: SD
authors.lastname: Weisbord
authors.forename: Lisa
authors.initials: L
authors.lastname: Weissfeld
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
mesh_terms: D000328:Adult; D000368:Aged; D005221:Fatigue / Q000209:etiology / Q000401:mortality*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000401:mortality*; D014481:United States / Q000453:epidemiology