Divisione di Nefrologia, Fondazione Policlinico A. Gemelli IRCCS, Roma; Università Cattolica del Sacro Cuore, Roma; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Limburg, The Netherlands.
School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Limburg, The Netherlands; Limburg Brain Injury Centre, Limburg, The Netherlands.
J Pain Symptom Manage. 2019 May;57(5):890-898.e4. doi: 10.1016/j.jpainsymman.2019.02.010. Epub 2019 Feb 16.
Fatigue is one of the most prevalent symptoms among hemodialysis (HD) patients. To design effective treatments, it is crucial to understand the diurnal pattern of fatigue in this population.
The objectives of this study were to assess diurnal changes in fatigue in patients undergoing hemodialysis and their relation with depressive symptoms and to explore whether fatigue may become a classically conditioned response to the hospital environment.
A prospective, observational study was conducted in 51 HD patients. Subjects repeatedly rated their current fatigue on three different days during one week of hemodialysis treatment to capture changes in momentary fatigue. First, on an HD treatment day, fatigue was measured one hour before and immediately before dialysis, as well as immediately after dialysis and again at 22:00 pm Second, on the postdialysis day and on the seventh weekday (when patients had not received treatment on the previous day), fatigue was measured at the same moments in time as the two measurements before dialysis on the treatment day. Beck Depression Inventory-II and Fatigue Severity Scale were administered to evaluate depressive mood and fatigue severity in daily life.
Fatigue increased as a result of hemodialysis treatment over the entire sample. However, diurnal fatigue patterns differed significantly between individuals high and low in depressive symptoms, with the former being fatigued more constantly throughout the day, and the latter experiencing increases in fatigue due to treatment. Pretreatment fatigue experienced in the hospital environment followed a pattern consistent with the development of a classically conditioned response.
Diurnal fatigue patterns during hemodialysis treatment are associated with depressive symptoms, and classical conditioning may play a role in the experience of pretreatment fatigue.
疲劳是血液透析（HD）患者最常见的症状之一。为了设计有效的治疗方法，了解该人群疲劳的昼夜模式至关重要。
本研究旨在评估血液透析患者的日间疲劳变化及其与抑郁症状的关系，并探讨疲劳是否可能成为对医院环境的经典条件反射。
进行了一项前瞻性、观察性研究，纳入了 51 名血液透析患者。受试者在一周的血液透析治疗期间的三天内反复评估当前的疲劳程度，以捕捉即时疲劳的变化。首先，在血液透析治疗日，在透析前 1 小时和前立即、透析后立即以及晚上 10 点再次测量疲劳程度。其次，在透析后日和第七个工作日（前一天未接受治疗时），在治疗日透析前的两次测量的同一时间测量疲劳程度。贝克抑郁量表二和疲劳严重程度量表用于评估日常生活中的抑郁情绪和疲劳严重程度。
整个样本中，由于血液透析治疗，疲劳程度增加。然而，在抑郁症状高和低的个体之间，日间疲劳模式存在显著差异，前者全天持续疲劳，后者由于治疗而疲劳增加。在医院环境中经历的预处理疲劳呈现出与经典条件反射发展一致的模式。
血液透析治疗期间的日间疲劳模式与抑郁症状有关，经典条件反射可能在预处理疲劳的体验中起作用。
