A Study On Fatigue Status And Related Factors In Maintenance Hemodialysis Patients

The fatigue of patients influences their daily life seriously, reduces their quality of life, increases the risk of cardiovascular events, and is one of the most important factors that determine their prognosis. Present researches illustrated that the incidence of fatigue in maintenance hemodialysis patients was high, with the majority of patients having varied levels of fatigue. Exploring the influencing factors of fatigue can help to plan effective intervention measures, enhance patients’ quality of life, and improve their prognosis. Therefore, it is essential to investigate the fatigue status and influencing factors in maintenance hemodialysis patients.Objectives This study is to describe the fatigue status of patients with maintenance hemodialysis in the three medical institutions in Shanghai, explore the influencing factors of fatigue in these patients, and propose effective intervention measures to the fatigue of maintenance hemodialysis patients.Methods This study is a descriptive study.140maintenance hemodialysis patients were recruited using a convenience sampling method in blood purification wards of three medical facilities from September2011to August,2012.The demographic questionnaire was completed by researchers when distributing questionnaires to patients. Questionnaires including fatigue assessment instrument (FAI), Pittsburgh sleep quality index (PSQI), Perceived social support scale (PSSS), the hospital anxiety and depression scale (HAD),and self-management scale of maintenance hemodialysis patients were given to patients after hemodialysis to be completed at home and returned to researchers when they came to hospital next time.Results140questionnaires were distributedand132(94.3%) were taken back, and122(92.4%) were effective among the sequestionnaires, resulting in122participants.The mean age of participants was59.58±12.18, range from31to84with the proportion of male and female being56.6%and43.3%respectively.The majority of patents (91%)didn’t work, and69.6%of patients had at least12years of education background. More than half of patients (63.9%) had one child,10.7%of patients had no children and the rest of patients had at least two children.The majority of patients (83.6%) had Shanghai medical insurance. Almost half of patients (44.3%) felt the economic burden was mild. In this study,65.6%of patients felt fatigue, and17.2%of patients felt moderate or heavy fatigue. Among4dimensions of fatigue assessment instrument (FAI), patients displayed mild fatigue in FAI1、FAI2、FAI3、dimensions, and showed moderate fatigue in dimension of FAI4.Among these participants,48.4%of patients had sleeping disorder and the rest of patients had normal sleeping,23%of patients had possible/confirmed anxiety, and32.8%of patients had possible/confirmed depression.The perceived social support of patients was high, with the mean score being61.66±13.11(total score is84). The mean scores of family inside support and family outside support were22.96±4.27(total score is28)and38.70±10.20(total score is58)respectively. The mean score of self-management scale was55.29±11.22(range from29to77), which was moderate level. The scores of four dimensions, i.e. partner relationship, problem solving, executive self-care, and emotion management, were12.21±2.99,14.63±3.47,19.02±4.56and9.43±3.02respectively. The sequence of mean item score of four dimensions were partner relationship(3.05),problem solving(2.93), executive self-care(2.72), and emotion management(2.36).Univariateanalysis showed that the fatigue of patients was correlated with gender, acute complications during hemodialysis, ultrafiltration volume and proportion of weight gain during hemodialysis, CRP level, quality of sleeping, level of anxiety and depression, social support, and self-management.Multivariate logistic analysiswas implemented to explore the influencing factors of patients’ fatigue, using fatigue as dependent variable, and gender, age, complication, proportion of weight gain,CRP, sleeping status,family inside support and family outside support, anxiety and depression, and self-management as independent variables. It was found that the incidence of fatigue among female was higher than that of males, patients with more than3complications were easier to feel fatigue than patients without complication, patients with CRP more than8mg/l had higher incidence of fatigue than those patients with CRP no more than8mg/l, and patient with better family inside support had less fatigue than those with lower family support.Conclusions65.6%of maintenance hemodialysis patients had the feeling of fatigue, and17.2%of them had moderate or heavy fatigue. This result implicate that nurses should pay more attention the problem of fatigue in hemodialysis patients and implement appropriate measures to relieve their fatigue.The fatigue of hemodialysis patient was correlated with gender, acute complications during hemodialysis, ultrafiltration volume and proportion of weight gain during hemodialysis, CRP level, quality of sleeping, level of anxiety and depression, social support, and self-management. Therefore, it is recommended to assess the status of sleeping, complication, psychological status, social support and so on, implement individualized psychological interventions to patients, improve the patients’cognitive level to disease, develop communication activities among patients, and encourage relatives to give more psychological support to patients, in order to enhance the psychological status of patients.It is found in logistic regression analysis thatgender, complication, CRP level, and family inside support were significant influencing factors of the fatigue of patients. Female patients had higher level of fatigue, patients with more than3complications were easier to feel fatigue than patients without complication, patients with CRP more than8mg/l had higher incidence of fatigue than those patients with CRP no more than8mg/l, and patient with better family inside support had less fatigue than those with lower family support.Therefore, it is recommended that during the nursing of female patients, more attention should be paid to their fatigues status. Education should be strengthened to reduce the complications of hemodialysis patients. At the same time, the social support of patients should be evaluated and appropriate psychological support can be provided to these patients when needed.The micro-inflammation status of patients should be concerned during the process of therapy, and measures should be implemented to reduce the level of patients’micro-inflammation.