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Nephrol Dial Transplant. 2013 Oct;28(10):2580-5. doi: 10.1093/ndt/gft097. Epub 2013 Jun 5.

Association of segmental wall motion abnormalities occurring during hemodialysis with post-dialysis fatigue.

Author information

1
Department of Medicine/Nephrology, San Francisco VA Medical Center/University of California, San Francisco, CA, USA.

Abstract

BACKGROUND:

Post-dialysis fatigue (PDF) is a common, debilitating symptom that remains poorly understood. Cardiac wall motion abnormalities (WMAs) may worsen during dialysis, but it is unknown whether WMA are associated with PDF.

METHODS:

Forty patients were recruited from University of California San Francisco-affiliated dialysis units between January 2010 and February 2011. Participants underwent echocardiograms before and during the last hour of 79 dialysis sessions. Myocardial segments were graded 1-4 by a blinded reviewer, with four representing the worst WMA, and the segmental scores were summed for each echocardiogram. Patients completed questionnaires about their symptoms. Severe PDF (defined as lasting >2 h after dialysis) was analysed using a generalized linear model with candidate predictors including anemia, intradialytic hemodynamics and cardiac function.

RESULTS:

Forty-four percent of patients with worsened WMA (n=9) had severe PDF, compared with 13% of patients with improved or unchanged WMA (P = 0.04). A one-point increase in the WMA score during dialysis was associated with a 10% higher RR of severe PDF [RR: 1.1, 95% CI (1.1, 1.2), P < 0.001]. After multivariable adjustment, every point increase in the WMA score was associated with a 2-fold higher risk of severe PDF [RR: 1.9, 95% CI (1.4, 2.6), P < 0.001]. History of depression was associated with severe PDF after adjustment for demographics and comorbidities [RR: 3.4, 95% CI (1.3, 9), P = 0.01], but anemia, hemodynamics and other parameters of cardiac function were not.

CONCLUSIONS:

Although cross-sectional, these results suggest that some patients may experience severe PDF as a symptom of cardiac ischemia occurring during dialysis.

KEYWORDS:

end-stage renal disease; hemodialysis; post-dialysis fatigue

PMID:
23743019
PMCID:
PMC3888101
DOI:
10.1093/ndt/gft097
[Indexed for MEDLINE]
Free PMC Article
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