• Jack Jacobson, Angela Ju, Amanda Baumgart, Mark Unruh, Donal O'Donoghue, Gregorio Obrador, Jonathan C Craig, Juan M Dapueto, Mary Amanda Dew, Michael Germain, Richard Fluck, Sara N Davison, Sarbjit Vanita Jassal, Karine Manera, Alice C Smith, and Allison Tong.
• Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
• Am. J. Kidney Dis. 2019 Aug 1; 74 (2): 179-192.

Rationale & ObjectiveFatigue is a highly prevalent and debilitating symptom in patients on hemodialysis therapy due to the uremic milieu, the hemodialysis treatment itself, and other comorbid conditions. However, fatigue remains underrecognized and the consequences are underappreciated because it may not be visible in clinical settings. This study aims to describe the experience that patients undergoing maintenance hemodialysis have with fatigue.Study DesignSystematic review and thematic synthesis of qualitative studies.Setting & Study PopulationsPatients undergoing hemodialysis.Search Strategy & SourcesMEDLINE, Embase, PsycINFO, CINAHL, reference lists, and PhD dissertations were searched from inception to October 2018.Data ExtractionAll text from the results/conclusion of the primary studies.Analytical ApproachThematic synthesis.Results65 studies involving 1,713 participants undergoing hemodialysis were included. We identified 4 themes related to fatigue: debilitating and exhausting burden of dialysis (bodily depletion, trapped in a vicious cycle of postdialysis exhaustion, vigilance and worry inhibiting rest, tiresome and agonizing regimen, and without remedy and relief), restricted life participation (deprived of time, managing energy reserves, frustrating need to rest, and joys foregone), diminishing capacities to fulfil relationship roles (losing ability to work and provide for family, failing as a parent, lacking stamina for sexual intimacy, and relying on others), and vulnerable to misunderstanding (being criticized for the need to rest and failing to meet expectations).LimitationsNon-English articles were excluded and most studies were conducted in high-income countries.ConclusionsFor patients undergoing hemodialysis who experience fatigue, fatigue is a profound and relentless exhaustion that pervades the entire body and encompasses weakness. The fatigue drains vitality in patients and constrains their ability to do usual activities and fulfill their roles and meet personal aspirations. Explicit recognition of the impact of fatigue and establishing additional effective interventions to improve fatigue are needed.Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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