Modifiable Factors Associated with Prolonged Dialysis Recovery Time and Fatigue in Hemodialysis Patients.

Background: Dialysis recovery time (DRT) and fatigue are two important patient-reported outcomes that highly affect hemodialysis patients' well-being and survival. This study aimed to identify all modifiable dialysis-related factors, associated with DRT and fatigue, that could be addressed in future clinical trials.

Methods: This multicenter observational study included adult patients, undergoing chronic hemodialysis for > 3 months during December 2023. Patients admitted to hospital, with cognitive problems, or active cancer were excluded. DRT was determined by asking over six sessions: "How long did it take you to recover from your last dialysis session?" Fatigue was assessed using the French-validated SONG-HD fatigue scale. Logistic regression analysis assessed the association between DRT>12 hours and fatigue score ≥4 with all dialysis-related factors. A sub-analysis of DRT-related factors was performed for very elderly ≥ 85 years.

Results: A total of 536 patients and 2967 sessions were analyzed. Mean age was 68.1 ±14.3 years, 60.9% were males, 33.2% had diabetes, 63.3% were on hemodiafiltration. Median dialysate sodium was 138 (136, 140). Median DRT was 140 (45, 440) minutes and 14.9% of patients had DRT >12 hours. Fatigue score was 3.1 ±2.3, 18% had no fatigue and 37.7% had a score ≥4. DRT and fatigue score were significantly associated. In multivariable regression analysis, intradialytic reduction in serum sodium and frequency of dialysis were significantly associated with DRT. Factors associated with fatigue included female sex and lower hemoglobin. In patients ≥85 years, hemodiafiltration was associated with prolonged DRT.

Conclusion: Modifiable factors associated with prolonged DRT are not exactly similar to those associated with fatigue. Intradialytic reduction in serum sodium and low frequency of dialysis are two independent factors associated with longer DRT, with hemodiafiltration associated with longer recovery in very elderly patients. The hemoglobin level is the modifiable independent factor associated with fatigue. These modifiable factors can be addressed in future interventional trials in order to improve patients' outcomes.