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. 2024 Sep 1;5(9):1311-1321.
doi: 10.34067/KID.0000000000000532. Epub 2024 Aug 2.

Modifiable Factors Associated with Prolonged Dialysis Recovery Time and Fatigue in Hemodialysis Patients

Mabel Aoun  1   2 , Eric Laruelle  3 , Gabrielle Duneau  1 , Simon Duquennoy  4 , Bruno Legendre  4 , Simona Baluta  5 , Thérèse Maroun  6 , Aldjia Lamri  7 , Morgane Gosselin  8 , Jonathan Chemouny  3 , Béatrice Champtiaux-Dechamps  1 , Juliette Baleynaud  1 , Lionel Le Mouellic  1 , Céline Bellier  3 , Marion Gritti  1 , Claire Cain  5 , Juliette Hervé  7 , Pauline Colin  5 , Sandrine Fleury  4 , Christel Floch  8 , Philippe Jousset  6 , Thibault Dolley-Hitze  9
Affiliations

Modifiable Factors Associated with Prolonged Dialysis Recovery Time and Fatigue in Hemodialysis Patients

Mabel Aoun et al. Kidney360. .

Abstract

Key Points:

  1. A negative change in serum sodium during a dialysis session is an independent factor associated with prolonged dialysis recovery time.

  2. Lower hemoglobin is an independent factor associated with fatigue in hemodialysis patients.

  3. Hemodiafiltration use in patients age ≥85 years is associated with a longer dialysis recovery time.

Background: Dialysis recovery time (DRT) and fatigue are two important patient-reported outcomes that highly affect hemodialysis patients' well-being and survival. This study aimed to identify all modifiable dialysis-related factors, associated with DRT and fatigue, that could be addressed in future clinical trials.

Methods: This multicenter observational study included adult patients, undergoing chronic hemodialysis for >3 months during December 2023. Patients admitted to hospital, with cognitive problems or active cancer were excluded. DRT was determined by asking over six sessions: How long did it take you to recover from your last dialysis session? Fatigue was assessed using the French-validated Standardized Outcomes in Nephrology-Hemodialysis fatigue scale. Logistic regression analysis assessed the association between DRT >12 hours and fatigue score ≥4 with all dialysis-related factors. A subanalysis of DRT-related factors was performed for very elderly patients aged 85 years and above.

Results: A total of 536 patients and 2967 sessions were analyzed. The mean age was 68.1±14.3 years, 60.9% were male, 33.2% had diabetes, and 63.3% were on hemodiafiltration. The median dialysate sodium was 138 (136–140). The median DRT was 140 (45–440) minutes, and 14.9% of patients had DRT >12 hours. Fatigue score was 3.1±2.3, 18% had no fatigue, and 37.7% had a score ≥4. DRT was significantly associated with fatigue score. In multivariable regression analysis, intradialytic reduction in serum sodium and frequency of dialysis were significantly associated with DRT. Factors associated with fatigue included female sex and lower hemoglobin. In patients aged 85 years and above, hemodiafiltration was associated with prolonged DRT.

Conclusions: Modifiable factors associated with prolonged DRT are not exactly similar to those associated with fatigue. Intradialytic reduction in serum sodium and low frequency of dialysis are two independent factors associated with longer DRT, with hemodiafiltration associated with longer recovery in very elderly patients. The hemoglobin level is the modifiable independent factor associated with fatigue. These modifiable factors can be addressed in future interventional trials to improve patients' outcomes.

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Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/KN9/A615.

Figures

None
Graphical abstract
Figure 1
Figure 1
Relationship between SONG-HD fatigue score and different categories of DRT. DRT, dialysis recovery time; SONG-HD, Standardized Outcomes in Nephrology-Hemodialysis.
Figure 2
Figure 2
Relationship between DRT and the change in serum sodium levels (postdialysis minus predialysis).
See this image and copyright information in PMC

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