#1588 Modifiable factors associated with fatigue and prolonged recovery time in hemodialysis patients: a French multicenter observational study
Authors: Aoun Mabel , Laruelle Eric , Duneau Gabrielle , Simon Duquennoy , Baluta Simona , Maroun Therese , Lamri Aldjia , Gosselin Morgane , Dolley-Hitze Thibault 
Published: May 2024

Abstract

Background and Aims
Fatigue and dialysis recovery time (DRT) are two important patient-reported outcomes that highly affect the well-being of patients on hemodialysis. The DOPPS working group showed that prolonged DRT increases mortality. Therefore, this study aims to assess all modifiable dialysis-related factors, associated with DRT and fatigue, that could be addressed in future clinical trials.

Method
This is a French multicenter observational study that included all patients ≥ 18 years, on chronic hemodialysis for &gt;3 months, who consented to participate during December 2023. Patients with cognitive problems, active cancer and admitted to hospital were excluded. The study got the approval of the local ethics committee. DRT was assessed six times by asking at each session for two non-consecutive weeks: "How long did it take you to recover from your last dialysis session?" Fatigue was assessed by using the French validated SONG-HD fatigue scale that includes three questions: in the last week, "did you feel tired?", "did you lack energy?", "did fatigue limit your usual activities?". Logistic regression analysis assessed the association between DRT&gt;12 hours and fatigue score ≥4 with all demographic and dialysis-related factors. A sub-analysis of DRT-related factors was performed for very elderly ≥ 85 years.

Results
A total of 536 patients and 2967 sessions were analyzed. Mean age was 68.1 ± 14.3 years with 10.4% above 85 years; 60.9% were males, median dialysis vintage was 41 (22.5, 80) months, 33.2% had diabetes, 46.3% had cardiovascular (CV) disease, 5.2% were on nocturnal hemodialysis, 14.4% had a catheter and 63.3% were on HDF. Median dialysate sodium was 138 (136, 140) with a minimum of 130 to a maximum of 142. Median DRT was 140 (45, 440) minutes with 42.7% of patients recovering in &lt;2 hours, 16.2% in 120-360 minutes, 26.1% in 361-720 minutes and 14.9% &gt;12 hours. The mean SONG-HD fatigue score was 3.1 ± 2.3 with 18% having no fatigue and 37.7% having a score ≥4. DRT and fatigue score were significantly associated (P &lt; 0.001). Factors significantly associated with DRT&gt;12 hours are summarized in Table 1: sex, diabetes, CV disease, BMI, ultrafiltration rate/Kg/hour, duration of session, blood flow, Kt/V, blood pressure, membrane type and all routine blood tests were not associated with DRT whereas intradialytic change in natremia was significantly associated with recovery time (Fig. 1). In multivariable regression analysis, factors associated with a fatigue score ≥4 included females (OR = 1.74; 95% CI: 1.21, 2.51; P = 0.003), and lower hemoglobin (OR = 0.83; 95% CI: 0.71, 0.99; P = 0.003). In the subgroup of patients ≥85 years, HDF was associated with prolonged DRT (OR = 4.2; 95% CI: 1.04, 17.03; P = 0.045) and lower hemoglobin was associated with fatigue (OR = 0.51; 95% CI :0.28, 0.93; P = 0.029).

Conclusion
DRT and fatigue are significantly associated however modifiable factors associated with prolonged DRT are not exactly similar to those associated with fatigue. A negative intra-dialytic change in natremia and low frequency of dialysis are two major factors associated with longer DRT, with HDF significantly associated with longer recovery in very elderly patients, whereas the modifiable independent factor associated with fatigue is the hemoglobin level.