Up to 40% of kidney transplant recipients (KTR) experience significant fatigue. Fatigue has been associated with clinical and psychosocial factors in other clinical cohorts, however, the associations have not been explored in KTR. This study investigates correlates of fatigue which may help guide management strategies for fatigue.
A cross-sectional, convenience sample of adult KTRs completed the Patient Reported Outcomes Measurement Information System (PROMIS) fatigue item bank, the Generalized Anxiety Disorder?7, the Patient Health Questionnaire?9, and the Social Difficulty Inventory on an electronic data capture system. Clinical characteristics were collected from medical records. Multiple imputation by chained equations was used to handle missing data. Multivariable adjusted linear regression models were used to assess the associations between fatigue and potential correlates.
385 patients (mean (SD) age 56 (17) years, 57% male and 79% transplanted >3 years before enrollment) were enrolled. The mean (SD) PROMIS fatigue score was 51 (11) and 27% of KTRs were classified as experiencing significant fatigue. Fatigue was correlated with anxiety (Rho=0.58), depressive symptoms (Rho=0.73), and social distress (Rho=0.61; p<0.001 for all). Weaker correlations were found for hemoglobin (Rho=-0.26) and serum albumin (Rho=-0.22; p<0.001 for both). In a multivariable adjusted (age, ethnicity, education, marital status, income, comorbidity and time since kidney transplant) linear regression model, moderate/severe (score of ?10) anxiety (coeff= 13.05;CI:9.87-16.27), depression (coeff= 13.08;CI:9.87-16.30) and social distress (coeff= 12.10 ;CI:10.02-14.19) were significantly associated with fatigue (p<0.001 for all). Female sex (coeff= 4.04; CI:1.82-6.26), lower serum albumin (coeff= -0.54;CI:-0.84- -0.25) and hemoglobin levels (coeff= -0.16;CI:-0.23- -0.09) were also significantly associated with higher fatigue scores.
Anxiety, depression and social distress were identified as potential correlates of fatigue. Female patients and patients with lower serum albumin and hemoglobin levels also had significantly higher fatigue scores. Further understanding of relationship between fatigue and psychosocial factors is necessary to improve fatigue management.