Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Alongside their reviews on treatments for chronic kidney disease, the Cochrane Kidney and Transplant Group produce reviews for interventions that might help with its consequences. These were added to in August 2023 with a new review of ways to help manage the fatigue experienced by people requiring dialysis. Here's lead author, Patrizia Natale from the University of Sydney in Australia, to tell us about the review.

Patrizia: Fatigue is common and debilitating in people on dialysis, and is associated with an increased risk of mortality, cardiovascular disease, and impaired quality of life. For patients receiving haemodialysis, both physiological factors, such as anaemia; and treatment-related factors, such as dialysis frequency or modality, have been shown to affect fatigue. And, through the international Standardised Outcomes in Nephrology (SONG) initiative; patients, caregivers and health professionals recently identified fatigue as a core outcome for reporting in all trials in people receiving haemodialysis.
Given its importance, therefore, we did this review to understand what interventions are effective in improving fatigue. There was already some evidence that both pharmacological and non-pharmacological interventions may improve fatigue. For example, some studies have shown that erythropoietin stimulating agents, diet, exercise, reflexology, and aromatherapy may all help, and that more frequent and longer dialysis treatment may reduce post-dialysis fatigue and improve general well-being.
In total, we found 94 studies involving more than 8000 adults, but the quality of the evidence was low or very low, due to imprecision, small sample sizes and low event rates. The studies came from 18 countries and fatigue was assessed using different tools in a wide range of heterogenous interventions, which limited our ability to pool and meta-analyse the data.
Considering the evidence as whole, the findings of the trials suggest that exercise, aromatherapy, massage and acupressure may improve fatigue in comparison to placebo or standard care. But the information about the effects of both pharmacological and non-pharmacological treatments on other outcomes, including death, cardiovascular diseases, vascular access, and quality of life was sparse and there were insufficient data to be sure about these effects. Similarly, adverse events were inconsistently assessed.
In summary, therefore, our review shows that exercise, aromatherapy, massage and acupressure may be effective in improving fatigue in people on dialysis but the effects of pharmacological and non-pharmacological interventions generally on other outcomes, including death, vascular access and quality of life remain uncertain. Adequately powered, high-quality studies on the efficacy of interventions for improving fatigue in people undergoing dialysis are needed to resolve this.

Mike: If you would like to read more about the evidence that is currently available and watch for updates of the review if those new studies get done, you can find the full review online. Just go to Cochrane Library and search 'fatigue and dialysis' to see a link to it.