Exercise, aromatherapy, massage and acupressure may improve fatigue in kidney failure patients requiring dialysis

"In patients receiving dialysis, pharmacological and other non‐pharmacological interventions had uncertain effects on fatigue or fatigue‐related outcomes," stated the review published in the Cochrane Database of Systematic Reviews. 

In patients receiving dialysis, fatigue is a common and debilitating symptom that is associated with an increased risk of cardiovascular disease, death, and depression. Fatigue can also impair QoL (quality of life) and the ability to participate in daily activities. Fatigue has been established by caregivers, patients, and healthcare professionals as a core outcome of haemodialysis (HD).

Patrizia Natale, University of Bari Aldo Moro, Bari, Italy, and colleagues aimed to evaluate the effects of pharmacological and non-pharmacological interventions on fatigue in patients with kidney failure receiving dialysis, including HD and peritoneal dialysis (PD), including any setting and frequency of the dialysis treatment.

For this purpose, the researchers searched online databases for studies evaluating pharmacological and non-pharmacological interventions affecting levels of fatigue or fatigue-related outcomes in people receiving dialysis. Studies were eligible if fatigue or fatigue-related outcomes were reported as a primary or secondary outcome. Any mode, prescription, frequency, and duration of therapy were considered.

Data extraction and risk of bias were assessed independently by three authors. Treatment estimates were summarized using random effects meta-analysis and expressed as a mean difference (MD) or risk ratio (RR). Confidence in the evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.

Ninety-four studies comprising 8191 randomised participants were eligible. Pharmacological and non-pharmacological interventions were compared either to placebo or control or to another pharmacological or non-pharmacological intervention.

The researchers reported the following findings:

• In the majority of domains, the risks of bias in the included studies were unclear or high.
• In low certainty evidence, when compared to control, exercise may improve fatigue (4 studies, 217 participants (Iowa Fatigue Scale, Modified Fatigue Impact Scale, Piper Fatigue Scale (PFS), or Haemodialysis-Related Fatigue scale score): SMD -1.18) in HD.
• In low certainty evidence, when compared to placebo or standard care, aromatherapy may improve fatigue (7 studies, 542 participants (Fatigue Severity Scale (FSS), Rhoten Fatigue Scale (RFS), PFS or Brief Fatigue Inventory score): SMD -1.23) in HD.
• In low certainty evidence, when compared to no intervention, massage may improve fatigue (7 studies, 657 participants (FSS, RFS, PFS or Visual Analogue Scale (VAS) score): SMD -1.06, 95% CI -1.47, -0.65; I2 = 81%) and increase energy (2 studies, 152 participants (VAS score): MD 4.87, 95% CI 1.69 to 8.06, I2 = 59%) in HD.
• In low certainty evidence acupressure may reduce fatigue (6 studies, 459 participants (PFS score, revised PFS, or Fatigue Index): SMD -0.64) in haemodialysis when compared to placebo or control.
• A wide range of heterogenous interventions and fatigue-related outcomes were reported for exercise, aromatherapy, massage and acupressure, preventing the capability to pool and analyse the data.
• Due to the paucity of studies, the effects of pharmacological and other non-pharmacological interventions on fatigue or fatigue-related outcomes, including non-physiological neutral amino acid, relaxation with or without music therapy, meditation, exercise with nandrolone, nutritional supplementation, cognitive-behavioural therapy, ESAs, frequent HD sections, home blood pressure monitoring, blood flow rate reduction, serotonin reuptake inhibitor, beta-blockers, anabolic steroids, glucose-enriched dialysate, or light therapy, were very uncertain.
• The effects of pharmacological and non-pharmacological treatments on death, cardiovascular diseases, vascular access, QoL, depression, anxiety, hypertension or diabetes were sparse.
• No studies assessed tiredness, exhaustion or asthenia. Adverse events were rarely and inconsistently reported.

"Aromatherapy, exercise massage and acupressure improve fatigue compared to placebo or standard care," the researchers wrote.

"There is no certainty on whether drugs or other non‐pharmacological interventions have any impact on fatigue in people on dialysis when compared to a sugar pill, standard care or other treatments for fatigue."

Reference:

Natale P, Ju A, Strippoli GF, Craig JC, Saglimbene VM, Unruh ML, Stallone G, Jaure A. Interventions for fatigue in people with kidney failure requiring dialysis. Cochrane Database Syst Rev. 2023 Aug 31;8:CD013074. doi: 10.1002/14651858.CD013074.pub2. PMID: 37651553.