CLINICAL QUESTION

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

EVIDENCE-BASED ANSWER

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.)

PRACTICE POINTERS

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.