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Introducción: La hemodiálisis es el tratamiento sustitutivo más empleado en fases avanzadas de enfermedad renal, aunque conlleva efectos adversos que afectan directamente la calidad de vida. Entre ellos destaca la fatiga postdiálisis, una sensación persistente de agotamiento que puede prolongarse durante horas o días, y cuyo impacto ha sido escasamente documentado.
Objetivos: Estimar la frecuencia de fatiga postdiálisis y el tiempo de recuperación en pacientes en hemodiálisis crónica, analizando variables clínicas, funcionales y subjetivas asociadas.
Material y Método: Estudio transversal realizado entre enero y abril de 2023 en un hospital público español. Se incluyeron pacientes con más de tres meses en tratamiento. Se recogieron datos demográficos, clínicos, funcionales, técnicos y percepciones de salud. La fatiga se definió por autorreporte. Se aplicaron análisis descriptivos y bivariantes.
Resultados: Se incluyeron 43 pacientes, con una edad media de 67,4 años, siendo .el 28% mujeres. El 53,5% reportaron fatiga postdiálisis, sin encontrar diferencias significativas por edad o sexo. Los pacientes que presentaron fatiga postdiálisis presentaron un mayor tiempo medio de recuperación (467,9±194,4 frente a 66,3±137,0 minutos; p<0,001), niveles más bajos de proteínas totales (6,1 frente a 6,5 g/L; p=0,022) y peor autopercepción de salud (p=0,026). No se hallaron asociaciones con otras variables clínicas ni técnicas.
Conclusiones: La fatiga postdiálisis es un evento frecuente y se asocia a mayor tiempo de recuperación y a marcadores clínicos y subjetivos de peor estado general. Su evaluación sistemática podría mejorar el abordaje integral del paciente en hemodiálisis.
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Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
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Referencias
- Romagnani P, Remuzzi G, Glassock R, Levin A, Jager KJ, Tonelli M, et al. Chronic kidney disease. Nature Reviews Disease Primers. 2017;3. https://doi.org/10.1038/nrdp.2017.88
- Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, Abebe M, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2020;395:709-33. https://doi.org/10.1016/S0140-6736(20)30045-3
- Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysis. PLoS One. 2016;11:e0158765. https://doi.org/10.1371/journal.pone.0158765
- Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: A systematic review. The Lancet. 2015;385:1975–82.https://doi.org/10.1016/S0140-6736(14)61601-9
- Himmelfarb J, Vanholder R, Mehrotra R, Tonelli M. The current and future landscape of dialysis. Nature Reviews Nephrology. 2020;16:573-85.https://doi.org/10.1038/s41581-020-0315-4
- Johansen KL, Chertow GM, Foley RN, Gilbertson DT, Herzog CA, Ishani A, et al. US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States. American Journal of Kidney Diseases.2021;77:A78. https://doi.org/10.1053/j.ajkd.2021.01.002
- Bolton S, Gair R, Nilsson L-G, Matthews M, Stewart L, McCullagh N. Clinical Assessment of Dialysis Recovery Time and Symptom Burden: Impact of Switching Hemodialysis Therapy Mode. Patient Relat Outcome Meas. 2021;Volume 12:315-21. https://doi.org/10.2147/prom.s325016
- Daugirdas JT. Pathophysiology of dialysis hypotension: An update. American Journal of Kidney Diseases.2001;38:S11-7. https://doi.org/10.1053/ajkd.2001.28090
- Lindsay RM, Heidenheim PA, Nesrallah G, Garg AX, Suri R. Minutes to Recovery after a Hemodialysis Session. Clinical Journal of the American Society of Nephrology. 2006;1:952-9. https://doi.org/10.2215/CJN.00040106
- Guedes M, Pecoits-Filho R, Leme JEG, Jiao Y, Raimann JG, Wang Y, et al. Impacts of dialysis adequacy and intradialytic hypotension on changes in dialysis recovery time. BMC Nephrol. 2020;21. https://doi.org/10.1186/s12882-020-02187-9
- Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Segev DL, Shafi T, et al. Frailty, Age, and Postdialysis Recovery Time in a Population New to Hemodialysis. Kidney360. 2021;2:1455-62. https://doi.org/10.34067/kid.0001052021
- Awuah KT, Afolalu BA, Hussein UT, Raducu RR, Bekui AM, Finkelstein FO. Time to recovery after a hemodialysis session: Impact of selected variables. Clin Kidney J. 2013;6:595-8. https://doi.org/10.1093/ckj/sft120
- Rayner HC, Zepel L, Fuller DS, Morgenstern H, Karaboyas A, Culleton BF, et al. Recovery time, quality of life, and mortality in hemodialysis patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases. 2014;64:86-94. https://doi.org/10.1053/j.ajkd.2014.01.014
- Elsayed MM, Zeid MM, Hamza OMR, Elkholy NM. Dialysis recovery time: associated factors and its association with quality of life of hemodialysis patients. BMC Nephrol. 2022;23. https://doi.org/10.1186/s12882-022-02926-0
- Hussein WF, Arramreddy R, Sun SJ, Reiterman M, Schiller B. Higher Ultrafiltration Rate Is Associated with Longer Dialysis Recovery Time in Patients Undergoing Conventional Hemodialysis. Am J Nephrol. 2017;46:3-10. https://doi.org/10.1159/000476076
- Bossola M, Picca A, Monteburini T, Parodi E, Santarelli S, Cenerelli S, et al. Post-dialysis fatigue and survival in patients on chronic hemodialysis. Journal of Nephrology. 2021;34:2163-5. https://doi.org/10.1007/s40620-021-01141-8
- Cohen L, Ruthazer R, Moss A, Al. E. Predicting six-month mortality for patients who are on maintenance hemodialysis. Clin J Am Soc Nephrol. 2010;5:72-9
- Weldring T, Smith SMS. Article Commentary: Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs). Health Serv Insights. 2013;6:HSI.S11093. https://doi.org/10.4137/HSI.S11093
- Guerraoui A, Prezelin-Reydit M, Kolko A, Lino-Daniel M, de Roque CD, Urena P, et al. Patient-reported outcome measures in hemodialysis patients: results of the first multicenter cross-sectional ePROMs study in France. BMC Nephrol. 2021;22. https://doi.org/10.1186/s12882-021-02551-3
- Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB. Development of the Kidney Disease Quality of Life (KDQOLTM) Instrument. Quality of Life Research. 1994;3:329-38. https://doi.org/10.1007/BF00451725
- Dou J, Liu H, Ma Y, Wu Y, Tao X. Prevalence of post-dialysis fatigue: a systematic review and meta-analysis. BMJ Open. 2023;13:e064174. https://doi.org/10.1136/bmjopen-2022-064174
- Bossola M, Tazza L. Postdialysis Fatigue: A Frequent and Debilitating Symptom. Semin Dial. 2016;29:222–7. https://doi.org/10.1111/sdi.12468
- Bossola M, Di Stasio E, Monteburini T, Parodi E, Ippoliti F, Cenerelli S, et al. Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate. Blood Purif. 2019;47:45-51. https://doi.org/10.1159/000492919
- Bellin EY, Hellebrand AM, Kaplan SM, Ledvina JG, Markis WT, Levin NW, et al. Post-dialysis recovery time in ESRD patients receiving more frequent hemodialysis in skilled nursing facilities. Hemodialysis International. 2022;26:424-34. https://doi.org/10.1111/hdi.13012
- Kodama H, Togari T, Konno Y, Tsuji A, Fujinoki A, Kuwabara S, et al. A new assessment scale for post-dialysis fatigue in hemodialysis patients. Ren Replace Ther. 2020;6:1. https://doi.org/10.1186/s41100-019-0252-5
- Zhang Y, Yang N, Bai X, Liu Y, Li X, Yan M, et al. Factors affecting postdialysis fatigue among hemodialysis patients: a multi-group path analysis according to nutritional status. Front Med (Lausanne). 2025;12. https://doi.org/10.3389/fmed.2025.1553751
Referencias
Romagnani P, Remuzzi G, Glassock R, Levin A, Jager KJ, Tonelli M, et al. Chronic kidney disease. Nature Reviews Disease Primers. 2017;3. https://doi.org/10.1038/nrdp.2017.88
Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, Abebe M, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2020;395:709-33. https://doi.org/10.1016/S0140-6736(20)30045-3
Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, et al. Global Prevalence of Chronic Kidney Disease – A Systematic Review and Meta-Analysis. PLoS One. 2016;11:e0158765. https://doi.org/10.1371/journal.pone.0158765
Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: A systematic review. The Lancet. 2015;385:1975–82.https://doi.org/10.1016/S0140-6736(14)61601-9
Himmelfarb J, Vanholder R, Mehrotra R, Tonelli M. The current and future landscape of dialysis. Nature Reviews Nephrology. 2020;16:573-85.https://doi.org/10.1038/s41581-020-0315-4
Johansen KL, Chertow GM, Foley RN, Gilbertson DT, Herzog CA, Ishani A, et al. US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States. American Journal of Kidney Diseases.2021;77:A78. https://doi.org/10.1053/j.ajkd.2021.01.002
Bolton S, Gair R, Nilsson L-G, Matthews M, Stewart L, McCullagh N. Clinical Assessment of Dialysis Recovery Time and Symptom Burden: Impact of Switching Hemodialysis Therapy Mode. Patient Relat Outcome Meas. 2021;Volume 12:315-21. https://doi.org/10.2147/prom.s325016
Daugirdas JT. Pathophysiology of dialysis hypotension: An update. American Journal of Kidney Diseases.2001;38:S11-7. https://doi.org/10.1053/ajkd.2001.28090
Lindsay RM, Heidenheim PA, Nesrallah G, Garg AX, Suri R. Minutes to Recovery after a Hemodialysis Session. Clinical Journal of the American Society of Nephrology. 2006;1:952-9. https://doi.org/10.2215/CJN.00040106
Guedes M, Pecoits-Filho R, Leme JEG, Jiao Y, Raimann JG, Wang Y, et al. Impacts of dialysis adequacy and intradialytic hypotension on changes in dialysis recovery time. BMC Nephrol. 2020;21. https://doi.org/10.1186/s12882-020-02187-9
Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Segev DL, Shafi T, et al. Frailty, Age, and Postdialysis Recovery Time in a Population New to Hemodialysis. Kidney360. 2021;2:1455-62. https://doi.org/10.34067/kid.0001052021
Awuah KT, Afolalu BA, Hussein UT, Raducu RR, Bekui AM, Finkelstein FO. Time to recovery after a hemodialysis session: Impact of selected variables. Clin Kidney J. 2013;6:595-8. https://doi.org/10.1093/ckj/sft120
Rayner HC, Zepel L, Fuller DS, Morgenstern H, Karaboyas A, Culleton BF, et al. Recovery time, quality of life, and mortality in hemodialysis patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases. 2014;64:86-94. https://doi.org/10.1053/j.ajkd.2014.01.014
Elsayed MM, Zeid MM, Hamza OMR, Elkholy NM. Dialysis recovery time: associated factors and its association with quality of life of hemodialysis patients. BMC Nephrol. 2022;23. https://doi.org/10.1186/s12882-022-02926-0
Hussein WF, Arramreddy R, Sun SJ, Reiterman M, Schiller B. Higher Ultrafiltration Rate Is Associated with Longer Dialysis Recovery Time in Patients Undergoing Conventional Hemodialysis. Am J Nephrol. 2017;46:3-10. https://doi.org/10.1159/000476076
Bossola M, Picca A, Monteburini T, Parodi E, Santarelli S, Cenerelli S, et al. Post-dialysis fatigue and survival in patients on chronic hemodialysis. Journal of Nephrology. 2021;34:2163-5. https://doi.org/10.1007/s40620-021-01141-8
Cohen L, Ruthazer R, Moss A, Al. E. Predicting six-month mortality for patients who are on maintenance hemodialysis. Clin J Am Soc Nephrol. 2010;5:72-9
Weldring T, Smith SMS. Article Commentary: Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs). Health Serv Insights. 2013;6:HSI.S11093. https://doi.org/10.4137/HSI.S11093
Guerraoui A, Prezelin-Reydit M, Kolko A, Lino-Daniel M, de Roque CD, Urena P, et al. Patient-reported outcome measures in hemodialysis patients: results of the first multicenter cross-sectional ePROMs study in France. BMC Nephrol. 2021;22. https://doi.org/10.1186/s12882-021-02551-3
Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB. Development of the Kidney Disease Quality of Life (KDQOLTM) Instrument. Quality of Life Research. 1994;3:329-38. https://doi.org/10.1007/BF00451725
Dou J, Liu H, Ma Y, Wu Y, Tao X. Prevalence of post-dialysis fatigue: a systematic review and meta-analysis. BMJ Open. 2023;13:e064174. https://doi.org/10.1136/bmjopen-2022-064174
Bossola M, Tazza L. Postdialysis Fatigue: A Frequent and Debilitating Symptom. Semin Dial. 2016;29:222–7. https://doi.org/10.1111/sdi.12468
Bossola M, Di Stasio E, Monteburini T, Parodi E, Ippoliti F, Cenerelli S, et al. Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate. Blood Purif. 2019;47:45-51. https://doi.org/10.1159/000492919
Bellin EY, Hellebrand AM, Kaplan SM, Ledvina JG, Markis WT, Levin NW, et al. Post-dialysis recovery time in ESRD patients receiving more frequent hemodialysis in skilled nursing facilities. Hemodialysis International. 2022;26:424-34. https://doi.org/10.1111/hdi.13012
Kodama H, Togari T, Konno Y, Tsuji A, Fujinoki A, Kuwabara S, et al. A new assessment scale for post-dialysis fatigue in hemodialysis patients. Ren Replace Ther. 2020;6:1. https://doi.org/10.1186/s41100-019-0252-5
Zhang Y, Yang N, Bai X, Liu Y, Li X, Yan M, et al. Factors affecting postdialysis fatigue among hemodialysis patients: a multi-group path analysis according to nutritional status. Front Med (Lausanne). 2025;12. https://doi.org/10.3389/fmed.2025.1553751