Interventions for Fatigue in Patients With Kidney Failure Who Are Receiving Dialysis

How do pharmacologic and nonpharmacologic interventions for fatigue affect people with kidney failure who are receiving dialysis?

Fatigue in people who have kidney failure and are receiving dialysis may be improved with exercise (standardized mean difference [SMD] = −1.18; 95% CI, −2.04 to −0.31), aromatherapy (SMD = −1.23; 95% CI, −1.96 to −0.50), massage (SMD = −1.06; 95% CI, −1.47 to −0.65), and acupressure (SMD = −0.64; 95% CI, −1.03 to −0.25) compared with patients receiving placebo, control, standard of care, or no intervention.¹ (Strength of Recommendation [SOR]: B, based on inconsistent or limited-quality patient-oriented evidence.)

Other pharmacologic and nonpharmacologic interventions have uncertain effects on fatigue in patients with kidney failure who are receiving dialysis.¹ (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.)

Fatigue is a subjective, overwhelming feeling of exhaustion that can negatively affect activities of daily living and impair social functioning.^2,3 Untreated fatigue can lead to depression, cardiovascular disease, poor quality of life, and death.^1,4 Between 42% and 89% of patients with kidney failure who are receiving dialysis experience fatigue.¹ The authors of this Cochrane review evaluated the effects of pharmacologic and nonpharmacologic interventions on fatigue in individuals with kidney failure who are receiving dialysis, including any type or frequency of dialysis treatment, in various clinical settings.

This Cochrane review included 94 studies involving 8,191 participants.¹ The studies were conducted in several countries, including the United States and Canada. Participants ranged from 38 to 69 years of age. Most received hemodialysis, whereas some received peritoneal dialysis. Fatigue assessment tools included the Piper Fatigue Scale and the Fatigue Severity Scale.

Compared with control, exercise may improve fatigue in patients with kidney failure receiving hemodialysis over a median follow-up period of 2.7 months (SMD = −1.18; 95% CI, −2.04 to −0.31; four studies; n = 217; low-certainty evidence). The interventions were nonstandardized protocols, including aerobic, leg ergometry, breathing, range-of-motion exercises, and electrical muscle stimulation.

Aromatherapy with lavender or orange extract, compared with placebo or standard care, may improve fatigue in patients who have kidney failure and are receiving hemodialysis over a median follow-up of 0.9 months (SMD = −1.23; 95% CI, −1.96 to −0.5; seven studies; n = 542; low-certainty evidence).¹ Compared with no intervention, massage improved fatigue in this population over a median period of 0.9 months (SMD = −1.06; 95% CI, −1.47 to −0.65; seven studies; n = 657; low-certainty evidence).

Acupressure, compared with placebo or control, may reduce fatigue experienced by patients with kidney failure undergoing hemodialysis therapy over a median follow-up of 1 month (SMD = −0.64; 95% CI, −1.03 to −0.25; six studies; n = 459; low-certainty evidence).¹

None of the randomized controlled trials were large or overly influential.¹ No studies showed conflicting results. Most studies that were grouped together as being relevant in this review showed similar results.

Because of the lack of studies, the effects of pharmacologic and other nonpharmacologic interventions on fatigue in patients with kidney failure who are undergoing dialysis were uncertain.¹ Few adverse effects were reported overall for any intervention.