International Urology and Nephrology

, Volume 50, Issue 7, pp 1341–1346 | Cite as

Fatigue is associated with high prevalence and severity of physical and emotional symptoms in patients on chronic hemodialysis

  • Maurizio Bossola
  • Enrico Di Stasio
  • Emanuele Marzetti
  • Katja De Lorenzis
  • Gilda Pepe
  • Carlo Vulpio
Nephrology - Original Paper



The symptom burden of fatigued hemodialysis patients is poorly known. We aimed to investigate possible differences in the prevalence and severity of symptoms between fatigued and not fatigued patients on chronic hemodialysis.


All prevalent patients on chronic hemodialysis referring to the Hemodialysis Service between January 2016 and June 2017 were considered eligible. The Dialysis Symptom Index (DSI) questionnaire was performed during the dialysis treatment. Patients underwent assessment of fatigue using the Italian version of the vitality scale of the SF-36 (SF-36VS).


We studied 137 patients: 107 (78.1%) were fatigued and 30 (31.9%) were non-fatigued. The median [95% CI] number of symptoms was 15 [14–16] for patients who reported fatigue and 9 [8–19] for the non-fatigued (P < 0.0001). In fatigued patients, with respect to non-fatigued ones, the prevalence of dry skin, itching, muscle soreness, bone or joint pain, restless legs, shortness of breath, feeling sad, feeling anxious, difficulty concentrating, and difficulty becoming sex aroused was significantly higher. Restless legs, feeling sad, difficulty concentrating, and difficulty becoming sex aroused were symptoms independently associated with fatigue. The severity of dry skin, trouble staying asleep, and bone/joint pain was higher in fatigued patients.


Fatigued hemodialysis patients report suffering from physical and emotional symptoms more frequently than non-fatigued patients. This finding suggests the need to accurately and routinely define the symptom burden of chronic hemodialysis patients and may help to investigate eventually common underlying pathogenic mechanisms of symptoms in these patients.


Hemodialysis Fatigue Symptom Burden Prevalence Severity End-stage renal disease 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hemodialysis Service, Institute of Clinical SurgeryCatholic University of the Sacred HeartRomeItaly
  2. 2.Department of Clinical ChemistryCatholic University of the Sacred HeartRomeItaly
  3. 3.Department of Geriatrics and GerontologyCatholic University of the Sacred HeartRomeItaly
  4. 4.Nurse Team Hemodialysis ServiceCatholic University of the Sacred HeartRomeItaly
  5. 5.Department of Emergency SurgeryCatholic University of the Sacred HeartRomeItaly

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