A qualitative exploration of fatigue in End-Stage Kidney Disease (ESKD)

Abstract

Background: Fatigue is commonly experienced in End-Stage Kidney Disease (ESKD) patients. In order to develop patient-centred psychosocial interventions to help patients manage fatigue symptoms, a more in-depth understanding regarding the experience fatigue is needed. Objective: The objective of this study was to explore renal patients’ experiences of fatigue, across renal replacement therapy (RRT). Methods: Twenty-five in-depth semi-structured interviews were conducted. Interviews were audiotaped, transcribed and analysed using inductive thematic analysis with elements from grounded theory and framework analyses. Results: Main themes included the strong role of the illness and treatment in the aetiology of fatigue. Two contrasting streams of illness-fatigue interpretations emerged: catastrophizing versus normalising. Patients emphasized the importance of having a sense of purpose in facilitating active management of fatigue. Many patients described the consequences of fatigue on their functioning. Low mood, frustration, and anger were common emotional consequences of fatigue. Three dominant fatigue management strategies emerged: one related to accommodation of activities around fatigue, another on increasing activities to counteract fatigue, and the third one revolved around self-compassion. Social support emerged as an important aspect of the fatigue experience, serving as a source of motivation, yet patients were wary of becoming a burden to others. Conclusion: Findings identify casual attributions, behavioural and emotional reactions, management strategies, and facilitators of active management of fatigue in ESKD. Untying fatigue from the illness and treatment may help patients to develop alternative less catastrophic perceptions of fatigue, increase their perception of control over fatigue, and facilitate active fatigue management.