title: Association of segmental wall motion abnormalities occurring during hemodialysis with post-dialysis fatigue.
abstract: BACKGROUND
  Post-dialysis fatigue (PDF) is a common, debilitating symptom that remains poorly understood. Cardiac wall motion abnormalities (WMAs) may worsen during dialysis, but it is unknown whether WMA are associated with PDF.
  
  
  METHODS
  Forty patients were recruited from University of California San Francisco-affiliated dialysis units between January 2010 and February 2011. Participants underwent echocardiograms before and during the last hour of 79 dialysis sessions. Myocardial segments were graded 1-4 by a blinded reviewer, with four representing the worst WMA, and the segmental scores were summed for each echocardiogram. Patients completed questionnaires about their symptoms. Severe PDF (defined as lasting >2 h after dialysis) was analysed using a generalized linear model with candidate predictors including anemia, intradialytic hemodynamics and cardiac function.
  
  
  RESULTS
  Forty-four percent of patients with worsened WMA (n=9) had severe PDF, compared with 13% of patients with improved or unchanged WMA (P = 0.04). A one-point increase in the WMA score during dialysis was associated with a 10% higher RR of severe PDF [RR: 1.1, 95% CI (1.1, 1.2), P < 0.001]. After multivariable adjustment, every point increase in the WMA score was associated with a 2-fold higher risk of severe PDF [RR: 1.9, 95% CI (1.4, 2.6), P < 0.001]. History of depression was associated with severe PDF after adjustment for demographics and comorbidities [RR: 3.4, 95% CI (1.3, 9), P = 0.01], but anemia, hemodynamics and other parameters of cardiac function were not.
  
  
  CONCLUSIONS
  Although cross-sectional, these results suggest that some patients may experience severe PDF as a symptom of cardiac ischemia occurring during dialysis.
authors.affiliation: Department of Medicine/Nephrology, San Francisco VA Medical Center/University of California, San Francisco, CA, USA.
authors.forename: Ruth F
authors.initials: RF
authors.lastname: Dubin
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Schiller
authors.forename: Dean
authors.initials: D
authors.lastname: Alokozai
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Johansen
mesh_terms: D000740:Anemia / Q000175:diagnosis / Q000209:etiology; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009068:Movement; D017711:Nonlinear Dynamics; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology
keywords: end-stage renal disease; hemodialysis; post-dialysis fatigue