Using Ecological Momentary Assessment to Redefine Postdialysis Fatigue in Patients with Kidney Failure

Key Points Many patients with kidney failure on thrice-weekly in-center hemodialysis reported worsening of both fatigue and mood symptoms posthemodialysis. Retiring the term “postdialysis fatigue” and replacing it with “postdialysis syndrome” would more accurately describe this phenomenon. Background Patients with kidney failure have a high symptom burden, and many report an acute exacerbation of symptoms immediately after in-center hemodialysis. Very few studies have used ecological momentary assessment to examine posthemodialysis patient-centered outcomes. Methods Participants in the Technology-Assisted Collaborative Care trial completed an automated telephone-administered Daytime Insomnia Symptom Scale at four time points daily for 7 consecutive days. The Daytime Insomnia Symptom Scale yields four symptom domain scores: Positive Mood, Negative Mood, Alert Cognition, and Sleepiness/Fatigue. Posthemodialysis symptom domains and item-level scores were compared with similar time points on nonhemodialysis days using linear mixed models analyses. Mixed models were also used to explore the association of postdialysis symptom burden with demographic, psychosocial, hemodialysis treatment, and disease-specific characteristics. All analyses were adjusted for age, race, sex, and Charlson Comorbidity Index. Results One hundred and fifty-six hemodialysis patients with available ecological momentary assessment data were evaluated (mean age=58±14 years, 55% men, 51% White). In the posthemodialysis period, patients reported significantly lower Positive Mood (mean difference [MD]=−0.22; 95% confidence interval [CI], −0.29 to −0.14) and Alert Cognition (MD=−0.13; 95% CI, −0.18 to −0.08) and higher Negative Mood (MD=0.12; 95% CI, 0.05 to 0.19) and Sleepiness/Fatigue (MD=0.51; 95% CI, 0.42 to 0.61) compared with nonhemodialysis days. The mean postdialysis symptom exacerbation total score was 0.70±1.21, representing an increase of 6% of the maximum scale range. In the postdialysis period, relative to nondialysis days, the mean decrease in Positive Mood and Alert Cognition scores equaled 4% and 2% of the maximum scale range, respectively; the mean increase in Negative Mood and Sleepiness/Fatigue scores equaled 2% and 9% of the maximum scale range, respectively. Conclusions Patients with kidney failure reported worsening of both fatigue and mood symptoms posthemodialysis. Clinical Trial registry name and registration number: Technology Assisted Stepped Collaborative Care Intervention, NCT03440853.