Kidney Week

Abstract: PUB134

Using Ecological Momentary Assessment to Redefine Postdialysis Fatigue

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Kallem, Cramer J., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

Cramer J. Kallem, PsyD

• Roumelioti, Maria-Eleni, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States

Maria-Eleni Roumelioti, MD

• Steel, Jennifer L., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

Jennifer L. Steel, PhD

• Erickson, Sarah Jane, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States

Sarah Jane Erickson, PhD

• Alghwiri, Alaa A., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

Alaa A. Alghwiri, PhD

• Yabes, Jonathan Guerrero, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

Jonathan Guerrero Yabes, PhD

• Unruh, Mark L., University of New Mexico School of Medicine, Albuquerque, New Mexico, United States

Mark L. Unruh, MD, MS

• Jhamb, Manisha, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States

Manisha Jhamb, MD, MPH

Background

Patients with ESKD have a high symptom burden and many report an acute exacerbation of symptoms immediately following hemodialysis (HD). While post-dialysis fatigue has been studied, very few studies have used ecological momentary assessment (EMA) to examine post-HD symptom experiences.

Methods

Participants in the Technology Assisted Collaborative Care (TACcare) trial completed an automated telephone-administered version of the Daytime Insomnia Symptom Scale (DISS) at 4 timepoints daily for 7 consecutive days. The DISS yields 4 symptom domain scores: Positive mood (PM), negative mood (NM), alert cognition (AC), and sleepiness/fatigue (SF). Post-HD symptom scores were compared to the corresponding timepoints on non-HD days via mixed models adjusting for age, race, sex, and Charlson Comorbidity Index. Demographic, psychosocial, and disease-specific characteristics were compared between patients who did versus did not show a post-HD increase of ≥1 point in the sum of SF and NM.

Results

160 HD patients were enrolled [mean age=58±14 years, 55% men, 52% White]. In the post-HD period, patients reported significantly lower PM [mean difference (MD)= -0.22, 95% CI (-0.29, -0.14), p<0.001] and AC [MD= -0.13, 95% CI (-0.18, -0.08), p<0.001] and significantly higher NM [MD=0.12, 95% CI (0.05, 0.19), p<0.001] and SF [MD=0.51, 95% CI (0.42, 0.61), p<0.001] symptoms, compared to non-HD days. Patients who endorsed an increase in symptoms (NM or SF ≥1 point) in the post-HD period reported lower baseline fatigue (on FACIT-F) than those who did not (p=0.02); no other between-group differences were observed.

Conclusion

Patients with ESKD tend to experience worsening of both fatigue and mood symptoms after HD treatments. Our findings align with recent critiques that the post-dialysis fatigue label does not fully describe the post-HD symptom burden patients experience. Future studies should utilize EMA to assess a broader range of potential post-HD symptoms.

Funding

• NIDDK Support