Hughes Anastasia, Ju Angela, Cazzolli Rosanna, Howell Martin, Guha Chandana, Levin Adeera, Manera Karine, Teixeira-Pinto Armando, Torrisi Luca G, Wheeler David C, Wong Germaine, Wu Rebecca, Jaure Allison
Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
BMJ Open. 2025 Jul 16;15(7):e099592. doi: 10.1136/bmjopen-2025-099592.
Fatigue is a common and debilitating symptom that is associated with an increased risk of mortality, dialysis initiation and hospitalisation among patients with chronic kidney disease (CKD). The aim of this study was to identify the characteristics, content and psychometric properties of patient-reported outcome measures (PROMs) used to measure fatigue in patients with CKD not requiring kidney replacement therapy (KRT).
Systematic review. The characteristics, dimensions of fatigue and psychometric properties of these measures were extracted and analysed.
We searched MEDLINE, Embase, PsycINFO and CINAHL from database inception to February 2023.
All studies that reported fatigue in patients with CKD stages 1-5 not receiving KRT.
We identified 97 studies (20 (21%) randomised trials, 2 (2%) non-randomised trials and 75 (77%) observational studies). 27 different measures were used to assess fatigue, of which three were author-developed measures. The 36-Item Short Form Health Survey (SF-36) and Kidney Disease Quality of Life - Short Form (KDQOL-SF) were the most frequently used measures (41 (42%) and 24 (25%) studies, respectively). Six (22%) measures were specific to fatigue (Chalder Fatigue Questionnaire, Functional Assessment of Chronic Illness Therapy - Fatigue Scale, Functional Assessment of Cancer Therapy-Fatigue, Fatigue Severity Scale, and author developed Chen & Ku 1998, and Hao 2021) while 21 (78%) included a fatigue subscale or item within a broader construct for example, quality of life. Various content domains assessed included tiredness, ability to think clearly, level of energy, muscle weakness, ability to concentrate, verbal abilities, motivation, memory, negative emotions and life participation. Only two measures (Chronic Kidney Disease Symptom Index - Sri Lanka, Kidney Symptom Questionnaire) were developed specifically for CKD, but they were not specific to fatigue. Six measures (Chronic Kidney Disease Symptom Index - Sri Lanka, Functional Assessment of Cancer Therapy - Anemia, Revised Illness Perception Questionnaire, Kidney Symptom Questionnaire, Short Form 6 Dimension and 36-Item Short Form Health Survey) had been validated in patients with CKD not requiring KRT.
PROMs used to assess fatigue in patients with CKD vary in content and few were specific to fatigue in patients with CKD not requiring KRT. Data to support the psychometric robustness of PROMs for fatigue in CKD were sparse. A validated and content-relevant measure to assess fatigue in patients with CKD is needed.
疲劳是一种常见且使人衰弱的症状，与慢性肾脏病（CKD）患者的死亡风险、开始透析及住院风险增加相关。本研究的目的是确定用于测量非肾脏替代治疗（KRT）的CKD患者疲劳程度的患者报告结局量表（PROMs）的特征、内容及心理测量特性。
系统评价。提取并分析这些量表的特征、疲劳维度及心理测量特性。
我们检索了从数据库建立至2023年2月的MEDLINE、Embase、PsycINFO和CINAHL。
所有报告1-5期未接受KRT的CKD患者疲劳情况的研究。
我们纳入了97项研究（20项（21%）随机试验、2项（2%）非随机试验和75项（77%）观察性研究）。使用了27种不同的量表来评估疲劳，其中3种是作者自行编制的量表。36项简短健康调查问卷（SF-36）和肾脏病生活质量简表（KDQOL-SF）是最常用的量表（分别有41项（42%）和24项（25%）研究使用）。6种（22%）量表是专门针对疲劳的（查尔德疲劳问卷、慢性病治疗功能评估-疲劳量表、癌症治疗功能评估-疲劳、疲劳严重程度量表，以及作者编制的Chen & Ku 1998年版和Hao 2021年版），而21种（78%）量表在更广泛的结构（如生活质量）中包含疲劳子量表或项目。评估的各种内容领域包括疲倦、清晰思考的能力、精力水平、肌肉无力、集中注意力的能力、语言能力、动力、记忆力、负面情绪和生活参与度。只有两种量表（斯里兰卡慢性肾脏病症状指数、肾脏症状问卷）是专门为CKD编制的，但并非专门针对疲劳。6种量表（斯里兰卡慢性肾脏病症状指数、癌症治疗功能评估-贫血、修订后的疾病认知问卷、肾脏症状问卷、简短健康调查问卷6维度版和36项简短健康调查问卷）在非KRT的CKD患者中得到了验证。
用于评估CKD患者疲劳程度的PROMs在内容上各不相同，很少有专门针对非KRT的CKD患者疲劳情况的量表。支持PROMs对CKD患者疲劳心理测量稳健性的数据很少。需要一种经过验证且与内容相关的量表来评估CKD患者的疲劳情况。
