The challenge to balance: how dialysis patients manage fatigue

Abstract

Background: Patients on dialysis treatment commonly experience severe fatigue. Fatigue is known as a stressful and intrusive symptom that strongly affects perceived quality of life. The aim of this study is to explore how dialysis patients respond to fatigue symptoms and manage its daily life impact. Methods: A qualitative study was conducted comprising 24 semi-structured interviews with patients with End-Stage Renal Disease (ESRD). All of them were on haemodialysis (HD), peritoneal dialysis (PD) or were able to retrospectively reflect on dialysis related fatigue after kidney transplantation. Participants were purposively recruited via the Dutch Renal Association and via the professional network of the involved researchers. Data were subjected to thematic analysis. Findings: Responses to immediate and enduring feelings of fatigue differed among patients, as well as strategies to manage and mitigate its consequences and causal and perpetuating factors. The analysis revealed six main themes of importance regarding response and strategies to manage fatigue: sleep behaviour, physical activity, energy distribution, mind-set, social context and purpose in life. Discussion: The way dialysis patients respond to fatigue symptoms and try to manage its consequences, involve physical, psychological, behavioural and social processes. Mitigating fatigue and adjusting to its daily life impact is often a solitary and individual process in which many ambiguities and difficulties are encountered. Person centered psychosocial support may be helpful in the search for the ultimate balance to reduce the burden of fatigue and contribute to the quality of life of dialysis patients.