Fatigue is a debilitating symptom experienced by many patients with chronic kidney disease (CKD) and has been associated with decreased quality of life. The Patient Reported Outcomes Measurement Information System (PROMIS) item banks assess domains of illness experience and quality of life, such as fatigue, that are relevant for individuals with chronic illness. Here we compare the prevalence of fatigue in kidney transplant recipients (KTRs) and patients on maintenance dialysis using PROMIS-57 Fatigue domain.
A cross-sectional, convenience sample of adult KTRs and patients on maintenance dialysis were recruited from several clinics across the Greater Toronto Area. Patients completed the PROMIS-57 questionnaire on an electronic data capture system. Clinical characteristics were collected from medical records. Multiple imputation by chained equations was used to handle missing data and multivariable adjusted linear regression and logistic regression models were used to assess the associations between fatigue and treatment modality (transplant or dialysis). Clinically potentially significant fatigue was defined as PROMIS-57 Fatigue score of ? 55.
A total of 321 participants were enrolled, 163 (51%) on dialysis and 158 (49%) KTRs. The mean (SD) PROMIS Fatigue score was higher in patients on dialysis compared to KTRs: 54 (12) vs 49 (11); p<0.001. Using half a standard deviation above the mean to indicate potentially significant fatigue, 79(48%) of the patients on dialysis were classified as experiencing potentially significant fatigue compared to 47(30%) of KTRs (p <0.001). After adjusting for clinical variables (hemoglobin levels and comorbidity), socio-economic variables (age, sex, ethnicity, education, marital status, income), and psychological factors (anxiety and depression), patients on dialysis had significantly higher fatigue score compared to KTRs (coeff=3.74; CI:0.74, 6.73, P=0.015. Accounting for the same confounders in multivariable adjusted logistic regression, dialysis patients were more likely to have significant fatigue compared to KTRs (OR 2.58; CI:1.06?6.31; P=0.037)
The results confirm that patients on dialysis experience significantly higher levels of fatigue compared to KTRs, although nearly 1 in 3 KTRs did experience potentially significant fatigue. Future research should assess correlates of fatigue to help improve assessment and management of fatigue in patients with chronic kidney disease.