Key result
Higher pain interference and opioid use were associated with increased odds of fatigue in adults on maintenance hemodialysis with chronic pain.
Why the study?
Fatigue is common in adults receiving hemodialysis and those with chronic pain, but factors associated with fatigue are not fully understood.
Cross-Sectional (n=636)
In adults on maintenance hemodialysis with chronic pain, factors such as pain interference, opioid use, depression, and sleep disturbances are significantly associated with increased fatigue.
Answers are grounded in this paper and cite their sources.
These cross-sectional associations in hemodialysis patients with chronic pain should not yet change practice; hypothesis-generating for targeted interventions on pain, mood, and sleep.
Rationale & Objective: Fatigue is commonly experienced by adults with kidney failure receiving hemodialysis and those with chronic pain, but factors associated with fatigue are not fully understood. We determined the prevalence of fatigue in a clinical trial cohort of adults receiving maintenance hemodialysis who have chronic pain and identified factors associated with fatigue. Study Design: A cross-sectional study. Setting & Participants: The baseline data from the HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis (HOPE Trial). Of the 643 participants randomized in the HOPE Trial, 636 had a baseline fatigue assessment and were included in this study. Exposures: Pain, sociodemographic, biological, dialysis-related, medical comorbid condition, psychological, and behavioral factors. Outcome: Fatigue was evaluated with the patient-reported outcomes measurement information system Fatigue SF 6a and defined as a T-score of ≥ 55. Analytical Approach: Logistic regression models. Results: Seventy-three percent of participants reported fatigue (n = 463), mean age was 60.4 (12.5), 289 (45.4%) were female, and 294 (46.2%) were Black/African American. In fully adjusted models, higher pain interference and opioid use in the last 14 days were each associated with higher odds of having fatigue (odds ratio ([OR) ] 1.37; 95% CI, 1.18-1.61; OR 1.80; 95% CI, 1.03-3.21, respectively), as were greater depressive symptoms and sleep disturbance (OR 1.21; 95% CI. 1.13-1.31; OR 1.08 95% CI 1.03-1.12, respectively). Higher physical function was associated with lower odds of having fatigue (OR 0.96 95% CI 0.93-0.99). Limitations: Fatigue assessed at one point in time. Conclusions: In adults receiving maintenance hemodialysis who have chronic pain, pain interference, opioid use, depression, and sleep disturbances are associated with increased odds of fatigue, and greater physical function is associated with lower odds of fatigue. Future work is needed to evaluate longitudinal associations, underlying mechanisms, and identify interventions.
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Hannan et al. (2025) conducted a cross-sectional in Kidney failure receiving maintenance hemodialysis with chronic pain (n=636). Higher pain interference was evaluated on Fatigue (PROMIS Fatigue SF 6a T-score ≥ 55) (OR 1.37, 95% CI 1.18-1.61). Higher pain interference and opioid use were associated with increased odds of fatigue in adults on maintenance hemodialysis with chronic pain.
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