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A prospective study of fatigue trajectories among in-centre haemodialysis patients, 2020, Picariello, Moss-Morris et al
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Psychological factors being 'fear avoidance', catastrophising, 'symptom focusing', 'damage beliefs', 'embarrassment avoidance', 'all or nothing behaviours' and 'avoidance behaviours'.
So, the association of death with fatigue suggests that the patients might have been perceiving things correctly. And the lack of associations between measured psychological factors and fatigue severity suggests that changing psychological factors probably isn't the answer.
The mean CFQ numbers (lower is less fatigued; >18 is regarded as 'fatigued') were:
Baseline: 17.34
12 months: 17.37
24 months: 18.26
36 months: 16.49
Much was made of a trend to less fatigue over time, and changes in the percentages of patients who were 'fatigued'. But the cohort was changing at each measurement, with some dying, some receiving a transplant and some dropping out of the study. And the scores were hovering around that fatigue threshold of 18. Really, there is no evidence for fatigue changing over time in any systematic way.
But here's the conclusion:
So, the researchers aren't sure what psychological deficiencies in dialysis patients need to be fixed, but they suggest the study has identified when the fixing should be done - although they don't say in the conclusion when that is.
Scrolling through the study trying to find out when they think the intervention should be delivered, I could only find this:
So, they say that at 24 months there is 'a change in the trajectory of fatigue severity'. Are they suggesting that the CBT for some yet to be identified psychological failing should be delivered at this point i.e. when the fatigue scores appear to naturally improve?
The paper is full of logical holes. And a lot of rather nasty patient blaming.
I feel sorry for patients already suffering from life changing and very unpleasant kidney problems needing dialysis being subjected to this nonsense. Can't someone stop them in their never ending quest to psychologise in such a negative way, and with so little evidence, every patient who dares to admit to fatigue.
For example, once fatigue develops as a consequence of underlying disease processes, interpretations of fatigue as uncontrollable and lasting, and unhelpful thinking styles in response to fatigue, such as catastrophizing, symptom focusing, or perceiving fatigue as a sign of bodily damage (damage beliefs), may lead to increased anxiety and low mood and subsequently unhelpful behavioural responses, such as excessive rest in an attempt to control fatigue and reduce the damage perceived it is doing to their body. Excessive rest may in turn lead to deconditioning, poor sleep and physiological arousal related to anxious mood, and lead to the perpetuation of fatigue
Blissfully unconstrained by evidence, as always.
Blissfully unconstrained by evidence, as always.
So even if you have a well documented and medically mainstream very serious disease you are still blamed for feeling seriously ill. 
Kidney disease, serious enough to require Haemodialysis (HD) is dreadful. The waste products you normally excrete build up until your next session, typically 3 times a week.
Your fluid intake and diet are hugely restricted.
These patients have every right to feel dreadful.
What is it with these Psychs and how are they continually accessing the funds for this this drivel!
Your fluid intake and diet are hugely restricted.
These patients have every right to feel dreadful.
What is it with these Psychs and how are they continually accessing the funds for this this drivel!
shak8
Senior Member (Voting Rights)
I worked as a nurse with chronic dialysis patients for twenty years.
A large chunk of the dialysis population is over 65, which can account for some increase in fatigue.
My observations always concluded that the more uremic (abnormal levels of nitrogen waste products the blood---this corresponds to how much residual kidney function a dialysis patient has and also how strictly they follow their limiting of protein in their diets) a patient is, the more fatigue they have.
The higher level of nitrogen wastes in the blood make them feel sicker, thus more fatigued. Those levels have a direct effect on the brain.
Also, when potassium levels are high (almost every patient has higher than normal potassium levels just before dialysis) muscles feel and are weak. Thus, fatigue.
And almost all have some degree of depression. They know that their livespans are greatly reduced once they get to the end stage renal failure.
Edited to add: Kidney function continues to deteriorate with time on dialysis. So, fatigue will increase for that reason, too.
A large chunk of the dialysis population is over 65, which can account for some increase in fatigue.
My observations always concluded that the more uremic (abnormal levels of nitrogen waste products the blood---this corresponds to how much residual kidney function a dialysis patient has and also how strictly they follow their limiting of protein in their diets) a patient is, the more fatigue they have.
The higher level of nitrogen wastes in the blood make them feel sicker, thus more fatigued. Those levels have a direct effect on the brain.
Also, when potassium levels are high (almost every patient has higher than normal potassium levels just before dialysis) muscles feel and are weak. Thus, fatigue.
And almost all have some degree of depression. They know that their livespans are greatly reduced once they get to the end stage renal failure.
Edited to add: Kidney function continues to deteriorate with time on dialysis. So, fatigue will increase for that reason, too.
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rvallee
Senior Member (Voting Rights)
Copy-paste research with copy-paste conclusions written from the start. Zero value, this informs nothing.
What this really shows is how completely arbitrary their stuff is, that whatever you put in, you always get the exact same thing out: the thing they believe. It also shows that patient predictions about their own course are generally reliable enough to serve as prognosis, probably not on a per-case basis but significantly more accurate than anything these fools have been trying for decades anyway. In a way, this is a massive ongoing self-own. But evidence does not matter in evidence-based medicine so whatever.
What this really shows is how completely arbitrary their stuff is, that whatever you put in, you always get the exact same thing out: the thing they believe. It also shows that patient predictions about their own course are generally reliable enough to serve as prognosis, probably not on a per-case basis but significantly more accurate than anything these fools have been trying for decades anyway. In a way, this is a massive ongoing self-own. But evidence does not matter in evidence-based medicine so whatever.
alktipping
Senior Member (Voting Rights)
this trash is published for profit the publishing houses make in excess of two and a half billion every year the ridiculous prices they charge to read texts that they get for free guarantees that considerable amounts of copy pasted drivel will be published . i wish the law makers would get of their collective buts and bring an end to these hugely fraudulent practices .
Snowdrop
Senior Member (Voting Rights)
Agreed, except that it's not fraud til after the lawmakers do the right thing. Until then it's merely creepily unethical. And stands as one of the pillars that will bring us into a dark age where everything anyone says is science. Because they said so. And they're an expert.
Mithriel
Senior Member (Voting Rights)
If doctors read these things at all the constant repetition will make this story sound true. We notice all the "mays" and "mights" but they are easy to miss. They are also an admission that there is no evidence for their theory. Obviously because they never test it just twist everything to make it sound true.
I used to maintain dialysis machines, including in people's homes.
Those patients are tired and unwell at least 50-60% of the time, are never 100% well, and have a bunch of serious complications from the kidney disease.
I wouldn't wish it on anybody.
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