# Risk Factors for Fatigue in Adults Receiving Maintenance Hemodialysis Who Have Chronic Pain: A Secondary Analysis of the HOPE Consortium Trial

## TL;DR

This study found that 73% of hemodialysis patients with chronic pain experience fatigue, linked to pain, opioid use, depression, and poor sleep.

## Contribution

The study identifies specific risk factors for fatigue in hemodialysis patients with chronic pain using clinical trial data.

## Key findings

- Higher pain interference and opioid use were associated with increased odds of fatigue.
- Depressive symptoms and sleep disturbances also increased fatigue risk, while better physical function reduced it.

## Abstract

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.

A cross-sectional study.

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.

Pain, sociodemographic, biological, dialysis-related, medical comorbid condition, psychological, and behavioral factors.

Fatigue was evaluated with the patient-reported outcomes measurement information system Fatigue SF 6a and defined as a T-score of ≥ 55.

Logistic regression models.

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).

Fatigue assessed at one point in time.

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.

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. Baseline data were examined from adults with kidney failure receiving hemodialysis who have chronic pain in the HOPE Trial. Fatigue was found in 73% of included participants. Higher levels of pain interference, opioid use, depressive symptoms, and sleep disturbances were each associated with higher odds of having fatigue. Higher levels of physical function were associated with lower odds of having fatigue. Future work is needed to evaluate causes of fatigue, to determine factors contributing to fatigue over time, and to identify interventions for fatigue in this population.