title: Predictors and consequences of fatigue in prevalent kidney transplant recipients.
abstract: BACKGROUND
  Fatigue has been underinvestigated in stable kidney transplant recipients (KTRs). The objectives of this study were to investigate the nature, severity, prevalence, and clinical awareness of fatigue in medically stable KTRs, examine the impact of fatigue on quality of life (QoL), and explore the underlying causes of posttransplantation fatigue.
  
  
  METHODS
  This single-center cross-sectional study enrolled 106 stable KTRs. Multi-dimensional Fatigue Inventory-20 was used to measure five fatigue dimensions: General Fatigue, Physical Fatigue, Reduced Activity, Reduced Motivation, and Mental Fatigue. Clinical awareness of fatigue was determined by reviewing medical records. QoL was assessed by Medical Outcomes Study Short Form-36 Questionnaire. Demographic, clinical, psychosocial, and behavioral parameters were evaluated as fatigue predictors.
  
  
  RESULTS
  Fatigue was found in 59% of KTRs. Only 13% had this symptom documented in medical records. Fatigue in KTRs was in the same range as chronically unwell patients, with Physical Fatigue, Reduced Activity, and Reduced Motivation approached levels observed in chronic fatigue syndrome. All fatigue dimensions significantly and inversely correlated with QoL (P<0.001 for all associations). Demographic predictors were male, older age, and non-Caucasian ethnicity (P≤0.05 for all associations). Clinical predictors included elevated highly sensitive C-reactive protein (inflammation), decreased estimated glomerular filtration rate (graft dysfunction), and reduced lean tissue index (P≤0.05 for all associations). Psychosocial and behavioral predictors were inferior sleep quality, anxiety, and depression (P<0.01 for all associations).
  
  
  CONCLUSIONS
  Fatigue is common and pervasive in clinically stable KTRs. It is strongly associated with reduced QoL. This study identified modifiable fatigue predictors and sets the scene for future interventional studies.
authors: 1 Department of Nephrology & Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK. 2 Department of Nutrition & Dietetics, Queen Elizabeth Hospital Birmingham, Birmingham, UK. 3 School of Sport and Exercise Sciences, The University of Birmingham, Birmingham, UK. 4 Division of Metabolic and Vascular Health, Clinical Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK. 5 Centre for Translational Inflammation Research, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, UK. 6 Address correspondence to: Richard Borrows, M.A., Department of Nephrology & Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Area 5, Level 7, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
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mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D016014:Linear Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009042:Motivation; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome