Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, London, UK.
The Richard Bright Renal Unit, North Bristol NHS Trust and The School of Clinical Sciences, University of Bristol, Bristol, UK.
Kidney Int. 2014 Sep;86(3):497-505. doi: 10.1038/ki.2014.86. Epub 2014 Apr 2.
Fatigue is commonly experienced in patients with advanced kidney disease and associated with poor outcomes. The prevalence of fatigue ranges from 42% to as high as 89% according to treatment modality and the measurement instruments used. This paper reviews studies examining sociodemographic, biological, and psychological factors associated with fatigue in advanced kidney disease. The association between fatigue and psychological factors, such as depression and anxiety, behavioral factors, such as sleep and nutrition, and cytokines, such as IL-6 and CRP corroborates the view of fatigue as a multidimensional and multifactorial problem. Although depression and fatigue are related, the relationship is typically moderate in size, thus fatigue should not simply be seen as a symptom of distress. Accordingly, it is important for treatment plans to address the complex etiology of fatigue through pharmacological and nonpharmacological interventions. To date, results of nonpharmacological interventions are promising, with physical exercise and cognitive-behavioral therapy showing beneficial results. Work conducted in other patient populations highlights the importance of cognitions and behaviors in the prediction and maintenance of fatigue. Such work could be applied to advanced kidney disease allowing a model of fatigue to be developed from which to base suitable interventions in this setting.
疲劳是晚期肾病患者常见的症状，与不良预后相关。根据治疗方式和使用的测量工具，疲劳的患病率从 42%到 89%不等。本文综述了研究晚期肾病患者疲劳相关的社会人口学、生物学和心理因素。疲劳与心理因素（如抑郁和焦虑）、行为因素（如睡眠和营养）以及细胞因子（如 IL-6 和 CRP）之间的关联，证实了疲劳是一个多维度和多因素的问题。虽然抑郁和疲劳相关，但这种关系通常是中等强度的，因此疲劳不应简单地被视为痛苦的症状。因此，治疗计划通过药物和非药物干预来解决疲劳的复杂病因非常重要。迄今为止，非药物干预的结果很有希望，身体锻炼和认知行为疗法显示出有益的结果。在其他患者群体中开展的工作强调了认知和行为在预测和维持疲劳方面的重要性。此类工作可应用于晚期肾病，从而可以从疲劳模型中为该环境下的适当干预措施提供依据。
