A meta-analytic systematic review of the effectiveness of psychosocial interventions for end-stage kidney disease fatigue

Abstract

Background: Fatigue affects 42-89% of End-Stage Kidney Disease (ESKD) patients, with huge repercussions on functioning and patient outcomes. Its management represents a clinical priority. The majority of currently available fatigue interventions in ESKD revolve around drug-treatments or exercise, with only modest and short-term improvements, unsuitable for patients in poorer health. The main aim of this systematic review was to explore whether controlled, theory-driven and effective psychosocial interventions are currently available to improve fatigue in ESKD. Methods: MEDLINE, PsycINFO, EMBASE, CINAHL, Global Health, Web of Science, and CENTRAL databases were searched to identify randomized controlled trials (RCTs) and quasi-RCTs that determined the effect of psychosocial interventions on fatigue, in the renal patient population. All included studies underwent quality and risk-of-bias assessments. A narrative synthesis and meta-analyses, where possible, will be undertaken. Preliminary/Expected Results: 16 RCTs, involving 1,375 renal patients, predominantly undergoing dialysis, were included. There was some evidence in favour of tailored interventions including cognitive-behavioural techniques, and education, targeting quality-of-life or sleep quality. In contrast, interventions targeting adherence to medications and fluid restrictions did not display any secondary benefits on fatigability. Current-Stage-of-Work: We are currently awaiting missing data and clarifications from authors, before proceeding to the meta-analytic stage. Discussion: The preliminary findings of this systematic review indicate that there is a lack of theory-driven interventions targeted specifically at fatigue in ESKD. Following in the footsteps of integrated models of fatigue and effective interventions developed in other chronic conditions, like cancer, it is important to adopt the same approach in ESKD.