Hemodialysis Fatigue: Just “Simple” Fatigue or a Syndrome on Its Own Right?

In this opinion article we discuss whether fatigue symptoms and signs often noticed in the hemodialysis (HD) patients should be collectively viewed and addressed as a “syndrome” and not in usual polarities such as peripheral vs. central fatigue, or, physical vs. mental fatigue etc. Our rationale follows the example of “Chronic Fatigue Syndrome (CFS)” to help us substantiate our argument. It is important to stress that “Sign” and “Symptom” are terms with different meanings; symptoms are problems that a patient perceives while signs are whatever features an observer can objectively detect or measure. In practice a syndrome combines symptoms, signs, and phenomena that the health practitioner recognizes, being alerted in that if some are observed then more are expected. In the case of what is being increasingly described as “HD fatigue” symptoms and signs may not have a very clear association resulting in ineffective or no action to remedy, partly because we have not yet identified/labeled them, as a scientific or health care community, as a group, i.e., as a syndrome. Chronic renal disease is a “silent epidemic” affecting up to 10% of the population in the USA, and Asian countries, with some sufferers progressing in to end-stage renal failure (Stenvinkel, 2010). Renal disease patients are characterized by progressively worsening muscle weakness and muscle atrophy due to both a metabolic and a disuse component collectively described as uremic myopathy. While various interventions in stable HD patients have helped these patients improve their functionality, they still have not proven enough to bring their muscle quality and quantity up to the levels of a healthy sedentary person (Sakkas et al., 2003b; Johansen et al., 2006). Moreover, patients present with sleep problems (Sakkas et al., 2008a), neurological and quality of life issues (Giannaki et al., 2011), anxiety, and/or symptoms of depression but most notably they complain of chronic fatigue and “lack of energy” (McCann and Boore, 2000).