University of Leicester
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Patient perspectives on the meaning and impact of fatigue in hemodialysis: systematic review and thematic analysis of qualitative studies

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Version 2 2020-04-28, 13:14
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journal contribution
posted on 2020-04-28, 13:14 authored by J Jacobson, A Ju, A Baumgart, M Unruh, D O’Donoghue, G Obrador, JC Craig, JM Dapueto, MA Dew, M Germain, R Fluck, SM Davison, S Vanita Jassal, K Manera, AC Smith, A Tong

Rationale & Objective

Fatigue is a highly prevalent and debilitating symptom in patients on hemodialysis therapy due to the uremic milieu, the hemodialysis treatment itself, and other comorbid conditions. However, fatigue remains underrecognized and the consequences are underappreciated because it may not be visible in clinical settings. This study aims to describe the experience that patients undergoing maintenance hemodialysis have with fatigue.

Study Design

Systematic review and thematic synthesis of qualitative studies.

Setting & Study Populations

Patients undergoing hemodialysis.

Search Strategy & Sources

MEDLINE, Embase, PsycINFO, CINAHL, reference lists, and PhD dissertations were searched from inception to October 2018.

Data Extraction

All text from the results/conclusion of the primary studies.

Analytical Approach

Thematic synthesis.


65 studies involving 1,713 participants undergoing hemodialysis were included. We identified 4 themes related to fatigue: debilitating and exhausting burden of dialysis (bodily depletion, trapped in a vicious cycle of postdialysis exhaustion, vigilance and worry inhibiting rest, tiresome and agonizing regimen, and without remedy and relief), restricted life participation (deprived of time, managing energy reserves, frustrating need to rest, and joys foregone), diminishing capacities to fulfil relationship roles (losing ability to work and provide for family, failing as a parent, lacking stamina for sexual intimacy, and relying on others), and vulnerable to misunderstanding (being criticized for the need to rest and failing to meet expectations).


Non-English articles were excluded and most studies were conducted in high-income countries.


For patients undergoing hemodialysis who experience fatigue, fatigue is a profound and relentless exhaustion that pervades the entire body and encompasses weakness. The fatigue drains vitality in patients and constrains their ability to do usual activities and fulfill their roles and meet personal aspirations. Explicit recognition of the impact of fatigue and establishing additional effective interventions to improve fatigue are needed.


Ms Ju is supported by a National Health and Medical Research Council (NHMRC) program grant (ID 1092957). Ms Manera is supported by an NHMRC program grant (ID 1092957). Dr Tong is supported by an NHMRC fellowship (ID 1037162). The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.



American Journal of Kidney Diseases Volume 74, Issue 2, August 2019, Pages 179-192

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/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Health Sciences


  • AM (Accepted Manuscript)

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American Journal of Kidney Diseases








Elsevier for National Kidney Foundation



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