Cochrane review: Interventions for fatigue in people with kidney failure requiring dialysis

[Sly Saint]

Are interventions for fatigue effective among people with kidney failure requiring dialysis?
What is the issue?

Fatigue is a frequent and debilitating symptom that can limit life participation in people receiving dialysis. Fatigue is linked to impaired quality of life, cardiovascular disease, death and depression in people on dialysis. Several potential interventions, including drugs or other non-pharmacological treatments (e.g. exercise, diet, massage, aromatherapy, acupressure), have been evaluated for their effect on fatigue in people on dialysis.

What did we do?

We evaluated whether drugs or other non-pharmacological interventions are beneficial for adults and children receiving haemodialysis or peritoneal dialysis to manage fatigue. We evaluated all clinical studies available and summarised the results. We evaluated how certain we could be about the evidence related to interventions for fatigue using a system called "GRADE".

What did we find?

Ninety-four studies involving 8191 randomised participants were available. Patients in the studies were given a drug, non-pharmacological intervention, standard care or a sugar pill (placebo). The treatment they received was decided by random chance. The studies were generally short-term (over a few months). There were no studies in children. Exercise, aromatherapy, massage and acupressure improve fatigue compared to placebo or standard care. Drugs or other non-pharmacological interventions have uncertain effects on fatigue in people on dialysis.

Conclusions

Exercise, aromatherapy, massage and acupressure improve fatigue compared to placebo or standard care. It remains uncertain 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.

This is the 'short version' from here
https://www.cochrane.org/CD013074/R...mong-people-kidney-failure-requiring-dialysis


From the full review:

Main results

Ninety‐four studies involving 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. In the majority of domains, 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, 95% CI ‐2.04 to ‐0.31; I2 = 87%) 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, 95% CI ‐1.96 to ‐0.50; I2 = 93%) 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, when compared to placebo or control, acupressure may reduce fatigue (6 studies, 459 participants (PFS score, revised PFS, or Fatigue Index): SMD ‐0.64, 95% CI ‐1.03 to ‐0.25; I2 = 75%) in HD.

A wide range of heterogenous interventions and fatigue‐related outcomes were reported for exercise, aromatherapy, massage and acupressure, preventing our 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.

Authors' conclusions
Exercise, aromatherapy, massage and acupressure may improve fatigue.


https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013074.pub2/full

 

[Ash]

They love to shovel the load onto the the back of this one little innocent bystander don’t they?

 

[Hutan]

Long version

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, 95% CI ‐2.04 to ‐0.31; I2 = 87%) 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, 95% CI ‐1.96 to ‐0.50; I2 = 93%) 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, when compared to placebo or control, acupressure may reduce fatigue (6 studies, 459 participants (PFS score, revised PFS, or Fatigue Index): SMD ‐0.64, 95% CI ‐1.03 to ‐0.25; I2 = 75%) in HD.

Plain language version

Exercise, aromatherapy, massage and acupressure improve fatigue compared to placebo or standard care.

Seems like some result inflation going on here. And the finding that aromatherapy, massage and acupressure relieve fatigue surely should be casting doubt on all of the studies with similar methodologies.

 

[Sly Saint]

Seems like some result inflation going on here. And the finding that aromatherapy, massage and acupressure relieve fatigue surely should be casting doubt on all of the studies with similar methodologies.

yes; why I posted it.
also note the use of 'may improve' in the full paper becomes a definitive 'improve' in the short version. How many other Cochrane reviews do this I wonder?

also

A wide range of heterogenous interventions and fatigue‐related outcomes were reported for exercise, aromatherapy, massage and acupressure, preventing our capability to pool and analyse the data.

didn't stop the group who did the exercise for cfs review.

 

[Trish]

I can see another campaign coming on. Cochrane has multiple reviews for psychological and alternative treatments for symptoms such as pain and fatigue in different conditions. They mostly use data from unblinded trials and subjective outcome measures. However useless such data is, they always seem to rate the evidence as medium or low, and recommend the treatments anyway. I think that's a key part of the fight about the CBT and exercise reviews for CFS. If they go down, a whole lot of other reviews will have to be withdrawn too. They are the crutch on which whole empires of CBT are built. It's time they were shown up for the empty nonsense they are.

 

[rvallee]

Exercise, aromatherapy, massage and acupressure improve fatigue compared to placebo or standard care

They removed the "may"?! This is completely misleading, and comes from the lowest possible quality of evidence with the highest possible level of bias.

If that doesn't tell you clearly and loudly that your methodology is completely invalid, I really don't know what to tell you. It's like finding that you can open a very strong locked safe resistant to standard lock-picking and power tools using a wet noodle wrapped up around old shredded newspaper, and cannot find anything wrong with it. It's completely ridiculous, not believable in the slightest.

Is there seriously anything at all that is valid in non-pharmaceutical interventions? Because the evidence strongly suggests that it is all completely made-up, since they keep finding that obviously invalid things are identical to things they do find valid, with the same terrible level of flimsy "evidence". There are hardly any better red flags than this.

It is part of core reasoning in every expert profession that finding invalid results among valid ones invalidates the seemingly valid ones. If a computer spits out the color blue, or a burning smell, or whatever, instead of the expected 32-bit number, you should question the whole damn thing and the validity of all 32-bit numbers it gives you before or after.

The complete absence of reasoning is shocking. They're taking fake numbers and doing a bunch of useless manipulations on them and somehow that's supposed to mean something? And the fact that exercise is in that lot is not the least bit surprising, it is equally good. As is reading your astrological sign backwards and singing in the rain. They are all equally capable of alleviating fatigue in a bunch of conditions.

They can't even properly define fatigue, FFS. Don't even know what it is, what it consists of. It's all vague mumbo-jumbo that belongs in a Goop convention between the patchouli stand and the healing crystals booth.

 

[shak8]

I heard dialysis patients complain of fatigue. Never did I hear anyone say: this or that improved my fatigue.

I doubt they had the energy to get up and go for another "treatment" (ie massage, acupressure).

Some wouldn't even bother to reach for a sniff from their flacon of tahitian vanilla on their bedside table.


How on earth could aromatherapy or massage put any dent into what happens when a major organ nearly ceases to function?

Prevention of renal disease is a good goal via universal access to health care and better health education of the public about risks of developing renal disease. Curbing the incidence of Type II diabetes and hypertension are key.

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