Background: Postdialysis fatigue (PDF) is not an unusual symptom among hemodialysis (HD) patients; however, its causes remain unclear. The aim of this study was to analyze the factors responsible for PDF in maintenance HD patients. Methods: This was a single-center cross-sectional study conducted between March 2018 and March 2019 at the Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University. One hundred and fifteen HD patients were enrolled. Clinical data on demographics, comorbidities, and the primary cause of end-stage renal disease were obtained by questionnaires. Laboratory data were collected pre- and post-HD. Participants were divided into 3 groups according to PDF degree. Results: The prevalence of PDF in participants was 60% (n = 69); 26.09% had mild PDF; and 33.91% had severe PDF. In the severe PDF group, the prevalence of intradialytic hypotension (IDH) was 38.46%, significantly higher than in the no PDF group (no-PDF; 8.70%) and mild-PDF (16.67%; p = 0.01 for both) groups. In the severe-PDF group, Charlson comorbidity index score and ultrafiltration rate were significantly higher than those in the no-PDF group (p = 0.040, p = 0.020, respectively). In the severe-PDF group, postdialysis lactic acid (Lac) level was significantly higher than that in the no-PDF or mild-PDF groups (p = 0.013 for both). And in the severe-PDF group, postdialysis sodium (Na) was significantly lower than that in the no-PDF or mild-PDF groups (p = 0.026 for both). It was shown by unconditional logistic regression analysis that IDH occurrence (OR 3.821, 95% CI 1.330–10.975), ultrafiltration rates (OR 1.142, 95% CI 1.018–1.281), lower postdialysis Na level (OR 0.724, 95% CI 0.556–0.942), and higher postdialysis Lac level (OR 2.465, 95% CI 1.126–5.397) were associated with PDF (p = 0.013, p = 0.024, p = 0.016, and p = 0.024, respectively). Conclusions: The prevalence of PDF was high among our study participants. PDF incidence was correlated with the IDH occurrence and higher postdialysis Lac and lower postdialysis Na levels. The level of Lac was a significant influencing factor for the fatigue of patients. More attention should thus be paid to PDF.

Collins AJ, Kasiske B, Herzog C, Chavers B, Foley R, Gilbertson D, et al. Excerpts from the United States Renal Data System 2004 annual data report: atlas of end-stage renal disease in the United States.
Am J Kidney Dis
. 2005 Jan;45(Suppl 1):A5–7.
Davenport A, Guirguis A, Almond M, Day C, Chilcot J, Da Silva Gane M, et al. Postdialysis recovery time is extended in patients with greater self-reported depression screening questionnaire scores.
Hemodial Int
. 2018 Jul;22(3):369–76.
Bossola M, Di Stasio E, Sirolli V, Ippoliti F, Cenerelli S, Monteburini T, et al. Prevalence and Severity of Postdialysis Fatigue Are Higher in Patients on Chronic Hemodialysis With Functional Disability.
Ther Apher Dial
. 2018 Dec;22(6):635–40.
Jhamb M, Pike F, Ramer S, Argyropoulos C, Steel J, Dew MA, et al. Impact of fatigue on outcomes in the hemodialysis (HEMO) study.
Am J Nephrol
. 2011;33(6):515–23.
Horigan AE. Fatigue in hemodialysis patients: a review of current knowledge.
J Pain Symptom Manage
. 2012 Nov;44(5):715–24.
Hassanzadeh M, Kiani F, Bouya S, Zarei M. Comparing the effects of relaxation technique and inhalation aromatherapy on fatigue in patients undergoing hemodialysis.
Complement Ther Clin Pract
. 2018 May;31:210–14.
Bossola M, Tazza L. Postdialysis Fatigue: A Frequent and Debilitating Symptom.
Semin Dial
. 2016 May;29(3):222–7.
Kristensen M, Albertsen J, Rentsch M, Juel C. Lactate and force production in skeletal muscle.
J Physiol
. 2005 Jan;562(Pt 2):521–6.
Sklar AH, Riesenberg LA, Silber AK, Ahmed W, Ali A. Postdialysis fatigue.
Am J Kidney Dis
. 1996 Nov;28(5):732–6.
Dubin RF, Teerlink JR, Schiller NB, Alokozai D, Peralta CA, Johansen KL. Association of segmental wall motion abnormalities occurring during hemodialysis with post-dialysis fatigue.
Nephrol Dial Transplant
. 2013 Oct;28(10):2580–5.
K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients.
Am J Kidney Dis
. 2005 Apr;45(4 Suppl 3):S1–153.
Chang TI, Paik J, Greene T, Desai M, Bech F, Cheung AK, et al. Intradialytic hypotension and vascular access thrombosis.
J Am Soc Nephrol
. 2011 Aug;22(8):1526–33.
Picariello F, Norton S, Moss-Morris R, Macdougall IC, Chilcot J. Fatigue in Prevalent Haemodialysis Patients Predicts All-cause Mortality and Kidney Transplantation.
Ann Behav Med
. 2019 May;53(6):501–14.
Horigan AE, Barroso JV. A Comparison of Temporal Patterns of Fatigue in Patients on Hemodialysis.
Nephrol Nurs J
. 2016 Mar-Apr;43(2):129–38.
Lindsay RM, Leitch R, Heidenheim AP, Kortas C; London Daily/Nocturnal Hemodialysis Study. The London Daily/Nocturnal Hemodialysis Study–study design, morbidity, and mortality results.
Am J Kidney Dis
. 2003 Jul;42(1 Suppl):5–12.
Jhamb M, Weisbord SD, Steel JL, Unruh M. Fatigue in patients receiving maintenance dialysis: a review of definitions, measures, and contributing factors.
Am J Kidney Dis
. 2008 Aug;52(2):353–65.
Caplin B, Kumar S, Davenport A. Patients’ perspective of haemodialysis-associated symptoms.
Nephrol Dial Transplant
. 2011 Aug;26(8):2656–63.
Rayner HC, Zepel L, Fuller DS, Morgenstern H, Karaboyas A, Culleton BF, et al. Recovery time, quality of life, and mortality in hemodialysis patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS).
Am J Kidney Dis
. 2014 Jul;64(1):86–94.
Kraut JA, Madias NE. Lactic acidosis.
N Engl J Med
. 2014 Dec;371(24):2309–19.
Seheult J, Fitzpatrick G, Boran G. Lactic acidosis: an update.
Clin Chem Lab Med
. 2017 Mar;55(3):322–33.
Dhakal MP, Kallay MC, Talley TE. Hemodialysis associated hypoxia extends into the post-dialysis period.
Int J Artif Organs
. 1997 Apr;20(4):204–7.
Meyring-Wosten A, Zhang H, Ye X, Fuertinger DH, Chan L, Kappel F, et al. Intradialytic Hypoxemia and Clinical Outcomes in Patients on Hemodialysis.
Clin J Am Soc Nephrol
. 2016 Apr;11(4):616–25.
Campos I, Chan L, Zhang H, Deziel S, Vaughn C, Meyring-Wosten A, et al. Intradialytic Hypoxemia in Chronic Hemodialysis Patients.
Blood Purif
. 2016;41(1-3):177–87.
Sridharan S, Vilar E, Davenport A, Ashman N, Almond M, Banerjee A, et al. Scaling Hemodialysis Target Dose to Reflect Body Surface Area, Metabolic Activity, and Protein Catabolic Rate: A Prospective, Cross-sectional Study.
Am J Kidney Dis
. 2017 Mar;69(3):358–66.
Zuo M, Tang J, Xiang M, Long Q, Dai J, Hu X. Relationship between fatigue symptoms and subjective and objective indicators in hemodialysis patients.
Int Urol Nephrol
. 2018 Jul;50(7):1329–39.
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