Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The measurement of the adequacy of dialysis in continuous ambulatory peritoneal dialysis (CAPD) is controversial. The use of weekly total creatinine clearance (TCC) has been recommended, but not validated. We analyzed data from our recent urea kinetics in a CAPD study to investigate TCC and its relationship to patient outcomes. TCC was measured over 24 hours by adding residual renal and peritoneal creatinine clearance, correcting for 1.73 m2 surface area and converting to a weekly value. Seventy-six patients had 218 measurements, on starting CAPD and then at 6-month intervals, with mean follow-up of 20 months (range 1-57 months). The mean TCC was 73.62 +/- 32.11 L/week. Due mainly to the loss of residual renal function, the TCC decreased with time (r = -0.40, p < 0.0001), from 88.65 L/week initially to 66.11 at one year, 59.84 at two years, and 50.47 at three years. Dialysate-to-plasma creatinine concentration ratios (D/P Cr) increased with time (r = 0.28, p < 0.0001) from 0.62 initially to 0.66 at one year and 0.73 at two years. The TCC correlated significantly with serum levels of creatinine (r = -0.46, p < 0.0001), urea (r = -0.21, p < 0.001), potassium (r = 0.14, p < 0.05), phosphate (r = 0.25, p < 0.001), and hemoglobin (r = 0.16, p < 0.01), but not with serum albumin or with clinical outcomes including technique failure, hospital days, transfusions, peritonitis rate, nerve conduction velocity, or subjective indices of well-being, except for a weak correlation with the fatigue index (r = 0.19, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Perit Dial Int 1992
PMID:Is total creatinine clearance a good predictor of clinical outcomes in continuous ambulatory peritoneal dialysis? 142 Apr 89

In six commercially available bicarbonate containing dialysates pH and pCO2 were determined. Side effects resulted from low pH and high pCO2. Use of two of the six dialysates was associated with fatigue, muscle cramps and somnolence.
Proc Eur Dial Transplant Assoc 1983
PMID:Side effects in bicarbonate dialysis due to low dialysate pH. 641 Mar 79

Quality of life is closely linked to our ability to meet the exercise challenges imposed on us by our daily round of activities and those we select as leisure time activities. Aerobic metabolism of fat and carbohydrates provides the energy to support our activities. An increase in aerobic capacity extends the range and duration of activities we can undertake without the premature onset of fatigue. An adequate oxygen delivery, especially to skeletal muscles, is central to the effective aerobic support of energy metabolism. Frequent exercise improves our aerobic capacity by a relatively modest increase in oxygen transport and a large improvement in the capacity of muscle to use oxygen delivered. This is achieved by an increase in mitochondrial density as well as an increase in capillarisation of skeletal muscles. A decrease in oxygen delivery, in active people, produces the same type of adaptive increases in aerobic capacity. Therefore, even though more haemoglobin is clearly better for active healthy individuals, frequent exercise can improve the capacity of renal patients to make the most effective use of their anaemia-imposed reduced oxygen delivery system.
Nephrol Dial Transplant 1995
PMID:Haemoglobin--is more better? 764 6

Continuous ambulatory peritoneal dialysis (CAPD) may not be tolerated by patients with chronic obstructive pulmonary disease (COPD) because of increased abdominal pressure in the standing position after instillation of peritoneal fluid. We report, here, a patient with COPD who had marked distress while on CAPD but was more comfortable with supine intermittent peritoneal dialysis. It is probable that the continuous high intraperitoneal pressure during CAPD caused diaphragmatic fatigue. During intermittent peritoneal dialysis, the supine position induces the least increase in intraperitoneal pressure; it may be the preferred mode of peritoneal dialysis for patients with COPD.
Adv Perit Dial 1994
PMID:Low-volume supine peritoneal dialysis in a chronic obstructive airway disease patient. 799 8

Fatigue and lethargy, common symptoms in uraemia, have been attributed to many factors. To assess possible bioenergetic contributions to this, we examined the forearm muscle of five patients in end-stage renal failure using 31P-magnetic resonance spectroscopy. There was a small increase in the ratio of intracellular inorganic phosphate to ATP in resting muscle, suggesting an increased cytosolic phosphate concentration. During exercise, increased phosphocreatine breakdown was accompanied by rapid intracellular acidification and an increase in calculated lactic acid accumulation in the muscle of the uraemic subjects, suggesting glycolysis dominating over oxidative phosphorylation as a source of ATP. After exercise, the half-time of phosphocreatine (PCr) recovery was longer in the uraemic subjects, suggesting diminished mitochondrial function. The initial rate of PCr resynthesis was not significantly decreased, but when account was taken of the high cytosolic ADP concentration (which drives mitochondrial oxidative ATP synthesis) the calculated maximum oxidative capacity was significantly reduced in the uraemic subjects. Thus there was evidence of mitochondrial dysfunction in uraemia due either to limitation of oxygen supply, reduced mitochondrial content, or an intrinsic mitochondrial defect. This resulted in increased phosphocreatine depletion and increased glycolytic ATP production during exercise and there was partial compensation of the mitochondrial abnormality by increased ADP concentration. In three of these patients studied after elevation of haemoglobin with erythropoeitin (from 8 to 12 g/dl), initial phosphocreatine breakdown and lactic acid accumulation during exercise were normalized, while exercise duration and calculated maximum oxidative capacity remained significantly abnormal. This suggests that anaemia contributes to these metabolic abnormalities but does not fully explain them.
Nephrol Dial Transplant 1993
PMID:Effect of chronic uraemia on skeletal muscle metabolism in man. 838 87

Quality of life assessments were performed in 24 haemodialysis patients (10 males, 14 females, age 45 +/- 15 years) undergoing rHuEpo treatment. The results in the rHuEpo-treated patients were compared with those in eight haemodialysis patients not on rHuEpo and with the results of a nationwide study of dialysis patients in Sweden (carried out before rHuEpo was registered). Survey questionnaires (112 items, divided into three dimensions, i.e. physical, social, and emotional wellbeing) were completed before treatment (Hb 73 +/- 1.1 g/l), when the target Hb value of 10 g/dl was reached (1-7 months) and in 14 patients 1 year after correction of the anaemia. Before treatment, the rHuEpo group had significantly more complaints about poor appetite, fatigue, and irritability than the controls. After the anaemia was corrected, the rHuEpo group had significantly improved physical and emotional wellbeing. The most significant changes occurred in satisfaction with health, physical activities of daily life, and fatigue. Alterations in emotional symptoms, such as depression and apathy, were less pronounced. Only minor changes were observed in their social wellbeing. One year after correction of the anaemia, the improvements in physical and emotional wellbeing were still present in the rHuEpo-treated patients. A positive effect was also noted on hospitalization rate. Scores for the subdimensions of satisfaction with health, sexual adjustment, physical symptoms, and emotional wellbeing improved in the rHuEpo-treated group and reached a level that was the same, or even higher, than the scores in the dialysis patients in the nationwide study. In conclusion, the quality of life improved during rHuEpo treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephrol Dial Transplant 1993
PMID:Long-term effects on quality of life in haemodialysis patients of correction of anaemia with erythropoietin. 839 47

A patient-reported checklist was used to assess adequacy of dialysis as measured by 24-hour creatinine clearance in 40 patients on chronic peritoneal dialysis. The checklist consisted of 13 symptoms, each scored from 0-5 with 0 = absent and 5 = severe. The total possible score was 0-65. Patients completed the checklist at the time of 24-hour dialysate and urine collections (in those with residual function) for creatinine clearance (CrCl). Arbitrary grouping by total CrCl in liters/week/1.73 m2 placed patients in one of two groups: those with CrCl < or = 48 L/week (n = 12) and those with CrCl > 48 L/week (n = 28). Patient age, sex, diabetes mellitus, months on peritoneal dialysis, mode of peritoneal dialysis, and hematocrit were not different between the two patient groups. More patients with CrCl > 48 L/week had endogenous renal function (19/28 vs 2/12, p = 0.004). The median total scores for the two patient groups were not significantly different (17 in those with CrCl < or = 48 L/week vs 13.5 in those with CrCl > 48 L/week, p = 0.40). The correlation between total score and CrCl was negative in both patient groups and stronger in those with the lower CrCl (-0.55 vs -0.44). Nausea/vomiting, fatigue, and weakness were the best predictors of CrCl < or = 48 L/week (-0.53, -0.56, -0.49, respectively). The checklist can identify patients with low CrCl and may be useful for following patients over time and altering dialysis prescriptions.
Perit Dial Int 1993
PMID:Patient-reported symptoms and adequacy of dialysis as measured by creatinine clearance. 839 70

Chronic hepatitis C is a common cause of viral liver disease in kidney transplant recipients. To assess the efficacy and the safety of therapy with interferon alpha (IFN alpha) in such a population we conducted a prospective study where 16 kidney transplant recipients with chronic hepatitis C received recombinant IFN alpha 3 million units three times weekly scheduled for 24 consecutive weeks. All the patients had stable renal function for at least 1 year (mean serum creatinine 125.4 +/- 41 mumol/l). Fifteen patients had a positive HCV viraemia at the beginning of the study. In 15 patients serum alanine aminotransferase (ALT) levels decreased rapidly and normalized (48 +/- 44 vs 98.5 +/- 46 IU/l; P = 0.0044). ALT remained in the normal range as long as IFN alpha was continued. Serum levels of gamma glutamyl transpeptidase decreased from 129.75 +/- 111.2 to 88 +/- 85 IU/l; P = 0.012). After discontinuation of IFN alpha therapy seven responders relapsed within 1-9 weeks. HCV viraemia assessed 1 month after the end of IFN alpha therapy remained positive in all the patients who scored positive at the beginning, i.e. 15. Side effects of IFN alpha (fatigue, anorexia, weight loss) were frequent leading to four patients dropping out of the study. The haematological tolerance was moderate. The major concern was the increase in serum creatinine (162.5 +/- 57.6 vs 125.4 +/- 41 mumol/l; P < 0.05). In fact only six patients experienced renal failure occurring 45-168 days after the beginning of IFN alpha. Kidney transplant biopsies showed oedema, scarce scattered interstitial inflammatory cellular infiltration and moderate mesangial hypertrophy.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephrol Dial Transplant 1995
PMID:Preliminary results of treatment of chronic hepatitis C with recombinant interferon alpha in renal transplant patients. 852 7

Haemodialysis is frequently complicated by side-effects both during and after treatment. Hypotension and muscle cramps have been attributed to depletion of intravascular volume; headache and fatigue have been attributed to rapid changes in intracellular and extracellular osmolality. An evidence-based systematic review of the English language literature was used to evaluate these hypotheses. Four studies have addressed the morbidity associated with changes in intravascular volume. These data suggest that during haemodialysis the vascular space is refilled from the interstitial space. Overhydrated patients are less likely to experience hypotension than are dehydrated patients, perhaps at the risk of congestive heart failure and hypertension. Intradialytic changes in haematocrit reflect changes in vascular volume and may be used to predict intradialytic hypotension. Eight studies have addressed the morbidity associated with changes in osmolality. In two of these studies the investigators reported clinical benefit for patients with patient-specific sodium profiles during dialysis. Four studies lacked sufficient statistical power to detect an effect of sodium profiling on patient symptoms. Two studies suggest a clinically important decrease in intradialytic symptoms during treatment with sodium-profiled dialysate. A definitive test of these hypotheses will require a randomized, blinded study of the clinical impact of sodium/ultrafiltration modelling on patient symptoms.
Nephrol Dial Transplant 1996
PMID:Sodium and water profiling in chronic uraemia. 904 39

There is a clear relationship between anaemia and cardiovascular risk in chronic renal failure (CRF) patients. Left ventricular hypertrophy (LVH) is present in about three-quarters of patients starting dialysis, and is a strong predictor of mortality. Anaemia contributes to the development of LVH, mainly via increased cardiac output. In some patients, anaemia results in an increase in LV mass, while in others it also results in LV end-diastolic volume dilatation. These changes increase the risk of arrhythmias, myocardial infarction and myocardial fibrosis. The lower the haemoglobin, the more likely it is that LVH and heart failure will develop. Furthermore, a haemoglobin of < 11 g/dl is associated with increased morbidity and mortality. Partial correction of anaemia with epoetin leads to a partial, but not complete, reversal of LVH. One large prospective study (Lombardy Registry) found that epoetin treatment was accompanied by a 30% reduction in crude relative risk of mortality. A progressive reduction in the relative risk of general and cardiovascular mortality was found with increasing haematocrit, with and without adjustment for co-morbid conditions. Mean hospitalizations also decreased with increasing haematocrit. The long-term effects of normalized haematocrit/haemoglobin values in uraemic patients have not yet been evaluated exhaustively in prospective, randomized, multicentre studies. Epoetin treatment has been shown to induce lasting improvements in patients' sense of well-being, reduce fatigue, increase appetite and work capacity, and improve exercise tolerance, libido and work performance. Further studies are needed to demonstrate whether greater haemoglobin concentrations are associated with greater improvements in quality of life during epoetin treatment.
Nephrol Dial Transplant 1999
PMID:What are the short-term and long-term consequences of anaemia in CRF patients? 1033 65


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