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American Journal of Kidney Diseases

Patient-Reported Outcome Measures for Fatigue in Patients on Hemodialysis: A Systematic Review

Published:November 29, 2017DOI:https://doi.org/10.1053/j.ajkd.2017.08.019

      Background

      Fatigue is a prevalent and debilitating symptom in patients receiving hemodialysis. We aimed to identify and evaluate the characteristics and psychometric properties of patient-reported outcome measures for fatigue in patients receiving hemodialysis, to inform the selection of a robust and feasible measure for use in randomized trials in hemodialysis.

      Study Design

      Systematic review of outcome measures for fatigue.

      Setting & Population

      Patients receiving hemodialysis.

      Search Strategy & Sources

      MEDLINE, Embase, PsycINFO, and CINAHL from inception to April 2017 were searched for all studies that reported fatigue in patients receiving hemodialysis.

      Analytical Approach

      With a focus on addressing methods, items (individual questions) from all measures were categorized into content and measurement dimensions of fatigue. We assessed the general characteristics (eg, number of items and cost) and psychometric properties of all measures.

      Results

      From 123 studies, we identified 43 different measures: 24 (55%) were developed specifically for the hemodialysis population (of which 18 were nonvalidated author-developed measures for use in their study only), 17 (40%) for other populations, and 2 (5%) for chronic kidney disease (all stages). The measures assessed 11 content dimensions of fatigue, the 3 most frequent being level of energy (19 [44%]), tiredness (15 [35%]), and life participation (14 [33%]); and 4 measurement dimensions: severity (34 [79%]), frequency (10 [23%]), duration (4 [9%]), and change (1 [2%]). The vitality subscale of the 36-Item Short Form Health Survey (SF-36) was the most frequently used (19 [15%] studies), but has only been tested for reliability in hemodialysis. Of the fatigue-specific measures, the Chalder Fatigue Scale was the only one evaluated in hemodialysis, but the full psychometric robustness remains uncertain.

      Limitations

      For feasibility, we searched for validation studies in the hemodialysis population using the names of measures identified in the primary search strategy.

      Conclusions

      A very wide range of measures have been used to assess fatigue in patients receiving hemodialysis, each varying in content and length. Many have limited validation data available in this population. A standardized and psychometrically robust measure that captures dimensions of fatigue that are important to patients is needed to estimate and improve this disabling complication of hemodialysis.

      Index Words

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      Linked Article

      • Assessing Fatigue in the ESRD Patient: A Step Forward
        American Journal of Kidney DiseasesVol. 71Issue 3
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          Patient-reported outcome measures (PROMs) as a way of assessing the health-related quality of life (HRQoL) of patients are now recognized as key outcome measures in clinical trials evaluating the impact of different renal replacement therapies for patients with end-stage renal disease (ESRD).1-6 Thus, recent studies comparing more frequent hemodialysis (HD) to conventional HD, home HD to center HD, extended HD to conventional treatments, and home peritoneal dialysis to center HD have all incorporated PROMs as important outcome measures.
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