title: Cardiovascular, muscular and perceptual contributions to physical fatigue in prevalent kidney transplant recipients.
abstract: Physical fatigue is debilitating and common among kidney transplant recipients (KTRs). This study investigated the mechanistic aetiology of physical fatigue in this setting through examinations of muscle mass, muscular and cardiovascular function, and perceived exertion. The incidence of physical fatigue, its association with quality of life (QoL), and the predictors of perceived exertion, were evaluated. This single-centre observational cross-sectional study enrolled 55 KTRs. Muscle mass was quantified using dual-energy x-ray absorptiometry. Muscular function was assessed by jumping mechanography. Cardiovascular function (maximal oxygen consumption and oxygen pulse) was estimated during submaximal exercise testing, with perceived exertion determined using age-adjusted Borg scale-ratings. Physical fatigue was measured using Multi-Dimensional Fatigue Inventory-20. QoL was assessed using Medical Outcomes Study Short Form-36. Demographic, clinical, nutritional, psychosocial and behavioural predictors of perceived exertion were assessed. Of clinical importance, increased perceived exertion was the only independent predictor of physical fatigue (P = 0.001), with no association found between physical fatigue and muscular or cardiovascular parameters. Physical fatigue occurred in 22% of KTRs, and negatively impacted on QoL (P < 0.001). Predictors of heightened perception included anxiety (P < 0.05) and mental fatigue (P < 0.05). Perception is a key determinant of physical fatigue in KTRs, paving the way for future interventions.
authors.affiliation: Department of Nephrology & Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.|School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.|Department of Nutrition & Dietetics, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Winnie
authors.initials: W
authors.lastname: Chan
authors.affiliation: School of Healthcare Science, Manchester Metropolitan University, Manchester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Jones
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.|Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jos A
authors.initials: JA
authors.lastname: Bosch
authors.affiliation: School of Healthcare Science, Manchester Metropolitan University, Manchester, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: McPhee
authors.affiliation: Department of Nuclear Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Crabtree
authors.affiliation: Division of Metabolic and Vascular Health, Clinical Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Philip G
authors.initials: PG
authors.lastname: McTernan
authors.affiliation: Department of Nephrology & Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Okdeep
authors.initials: O
authors.lastname: Kaur
authors.affiliation: Department of Nephrology & Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Inston
authors.affiliation: Department of Nephrology & Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Moore
authors.affiliation: Department of Nephrology & Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: McClean
authors.affiliation: Department of Nephrology & Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Harper
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Phillips
authors.affiliation: Department of Nephrology & Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK.|Translational Inflammation Research, University of Birmingham, Birmingham, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Borrows
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology; D010101:Oxygen Consumption; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D011788:Quality of Life; D006113:United Kingdom / Q000453:epidemiology
keywords: cardiovascular; fatigue; kidney; muscular; perception; transplant