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Psychosocial and Clinical Correlates of Fatigue in Haemodialysis Patients: the Importance of Patients’ Illness Cognitions and Behaviours

International Journal of Behavioral Medicine volume 23, pages 271–281 (2016)Cite this article

A Correction to this article was published on 20 October 2017

This article has been updated

Abstract

Purpose

Fatigue is commonly experienced in end-stage kidney disease (ESKD) and is associated with poor outcomes. Currently, little research has examined the psychosocial correlates of fatigue severity and its impact on renal disease patients. We predicted that psychological factors (distress, cognitions and behaviours) would be associated with fatigue severity and impairment in ESKD patients even when controlling for clinical and disease factors.

Method

One hundred seventy-four haemodialysis patients completed the Chalder Fatigue Questionnaire (fatigue severity) and the Work and Social Adjustment Scale (fatigue-related impairment) in addition to measures evaluating distress, fatigue perceptions, symptom beliefs and behaviours. Demographic and clinical data were also collected.

Results

Fatigue severity was not related to haemoglobin levels, serum albumin or dialysis vintage. In hierarchical regression models, demographic and clinical factors explained 20 % of the variance in fatigue (ethnicity, body mass index, exercise, log C-reactive protein and multimorbidity). Psychological distress (beta = 0.21, p < 0.01), negative beliefs about fatigue (beta = 0.10, p = 0.01) and unhelpful behaviours (all-or-nothing behaviour [beta = 0.28, p < 0.01] and avoidance [beta = 0.16, p < 0.01]) explained an additional 36.4 % of the variance. Fatigue-related impairment was associated with psychological distress, perceptions that symptoms indicate damage, avoidance behaviour and the level of fatigue severity.

Conclusion

Patients’ mood, beliefs and behaviours are associated with fatigue in dialysis patients. Psychological interventions to alter these factors may reduce fatigue severity and fatigue-related disability in ESKD patients.

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Fig. 1

Change history

  • 20 October 2017

    We wish to highlight a discrepancy with regards to the reported mean fatigue severity score (mean = 28.3, standard deviation = 6.5). Since publication we have followed this sample up over time and are currently evaluating the longitudinal trajectories of fatigue severity.

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Acknowledgments

We wish to thank the patients and staff of King’s College Hospital Renal Unit for supporting this study. This study received no direct research funding.

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Affiliations

  1. Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Joseph Chilcot, Rona Moss-Morris, Micol Artom, Larissa Harden, Federica Picariello & Sarah Bates

  2. Department of Renal Medicine, King’s College Hospital, London, UK

    Hector Hughes & Iain C. Macdougall

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  1. Joseph Chilcot
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  2. Rona Moss-Morris
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  7. Sarah Bates
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Correspondence to Joseph Chilcot.

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The authors declare that they have no competing interests.

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All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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A correction to this article is available online at https://doi.org/10.1007/s12529-017-9692-x.

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Chilcot, J., Moss-Morris, R., Artom, M. et al. Psychosocial and Clinical Correlates of Fatigue in Haemodialysis Patients: the Importance of Patients’ Illness Cognitions and Behaviours. Int.J. Behav. Med. 23, 271–281 (2016). https://doi.org/10.1007/s12529-015-9525-8

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  • DOI: https://doi.org/10.1007/s12529-015-9525-8

Keywords

  • Fatigue
  • Symptoms
  • Dialysis
  • Haemodialysis
  • Illness beliefs
  • Illness perception