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

While HD per se is a life saving procedure, it cannot substitute for a healthy kidney, it taxes the patient and HD related fatigue symptoms significantly affect patients' quality and way of life as suggested by Muscle status is gravely affected with HD patients demonstrating severe atrophy, fat infiltration, and other anomalies (Sakkas et al., 2008b). Overall, HD patients exhibit low levels of physical activity and functional capacity while they suffer from generalized weakness, exercise intolerance, and muscle atrophy, all leading to generalized sense of fatigue (Johansen and Painter, 2012). The causes of fatigue in HD patients are not well understood but it is been shown that these should include both muscular and central activation failures (Johansen et al., 2005). Moreover, correction of anemia (Jhamb et al., 2011), exercise training (Koufaki et al., 2002; Sakkas et al., 2003b) with or without anabolic steroid (Johansen et al., 2006), and/or nutritional supplements (Kalantar-Zadeh et al., 2011) do improve the clinical condition of the HD patients, however, despite such improvements, we have observed that HD patients' functional capacity cannot equal that of a sedentary aged matched healthy counterpart. A cause of the observed minimal levels of physical activity is probably that the HD procedure per se [e.g., duration of dialysis sessions (Caplin et al., 2011) etc.,] contributes to fatigue. One third of the patients report that they feel worse in the immediate hours after the dialysis session while one out of four reports severe or very severe intensity of fatigue after dialysis (Gordon et al., 2011). The severity of " Post-dialysis 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). The traditional approach in identifying, researching, and assessing signs of fatigue has a dual nature: central vs. peripheral, brain vs. muscle, physical vs. mental etc. Mental fatigue is a psychobiological state caused by prolonged and intensive cognitive activity and is expressed by the lack of concentration and the inability of staying focused under certain conditions (Marcora et al., 2009). Physical (muscle) fatigue on the other hand is accepted mainly as an inability to exert or sustain muscle force or power output for a given task (Edwards, 1975). Moreover, there is heated discussion in the literature on the origins and …