Fatigue Management in Patients With ESRD Undergoing CAPD - Coursework Example

Among the most common side effects that are noticed in majority of the dialysis patients, fatigue standouts more. The problems in the quality of life that they are leading can be attributed to fatigue (Jhamb, Weisbord, Steel & Unruh, 2008). Fatigue can also be classified as a subjective obnoxious sign that is as a result of exhaustion and tiresome activities which hinder one from carrying out the normal day to day activities (Ream & Richardson, 1996). In studies that have been conducted, fatigue has been termed as a recurrent symptom that is associated with ESRD patients. There is a 60% to 97% chance of fatigue as a symptom in patients who are under dialysis (Murtagh et al., 2007; Unruh et al., 2004; Weisbord et al., 2005).

Fatigue management in patients with ESRD undergoing CAPD

Majority of the patients undergoing dialysis have irritations and suffering due to fatigue. There have been many studies that have been conducted in order to come up with a way to manage the levels of fatigue in patients who are under dialysis in ESRD. There are two methods in which fatigue can be managed in the patients in ESRD who are under CAPD. These methods are the pharmacological method and the non pharmacological method. In this paper we will analyze and briefly describe these approaches.

1. Pharmacological approach

Erythropoietin is a hormone that is naturally found in the body but it however becomes undersupplied due to renal impairment (Foley, Curtis, & Parfrey, 2009).the main function of this hormone is to stimulate the production of red blood cells in the body. Patients who are under dialysis have levels of Erythropoietin that are very low. This low levels means that the production of red blood cells in the body is not enough and hence they develop anaemia.

These patients are remedied by being given recombinant human erythropoietin (EPO) so as to help in the production of red blood cells in the body and thus raising the levels of haemoglobin. It is still not clear what the optimal level of haemoglobin in dialysis patients should be. For a person who is perfectly healthy, the adult male should have 13.5-18 g/dL while the adult female is 12-16 g/dL. In order to achieve these levels with dialysis patients, EPO has been used even though it has been found to be unsafe due to the high chances of cardiovascular as well as cerebrovascular events (Singh et al., 2006). These finds are the factors that led to the National Kidney Foundation recommendation hemoglobin level of 11 g/dL and 12 g/dL, not to exceed 13 g/dL, for patients on dialysis (National, 2006). Regardless of the conflict in opinion regarding this matter, treatment of anemia from kidney failure by use of EPO has proved to be effective in managing fatigue in patients who are under dialysis.

In a study that was conducted by Keown and colleagues (2010), patients who are under dialysis and were treated with Epoetinalfa showed signs of improvement for anemia. The Kidney Disease Questionnaire was used to measure fatigue in this case. The results showed that the patients who were under EPO treatment had a considerable improvement from fatigue in the baseline to the tow month follow up period in reference to those who were treated with placebo (r2 = 0.395, p =.03). This may lead to the conclusion that reducing the hemoglobin levels is more effective in reducing the levels of fatigue in patients who are under dialysis but the high levels that are evident may prove to be detrimental to the patient.

2. Non-pharmacological approaches

This method groups the activities into two. This is the physical activity and the alternative therapy.

2.1 Physical Activity

This only increases the levels of fatigue in the patients undergoing dialysis. In a study conducted by Chang and colleagues (2010), they evaluated the effects of intradialytic leg ergometry exercises on improving fatigue in patients who are suffering from kidney failure by use of the Quasi experimental. There were 71 dialysis patients that were used in this study. Exercise was used with leg ergometer while supine preceded by a 5-minute stepping warm-up, followed by gradual increase in exercise time 10, 20, and 30 minutes during the first hour of dialysis after vital signs assessed.

The span of this intercession was two months. Weariness scale (Chung and Kao) were utilized and measured at 4 and two months of mediation. The analysts found that it has fundamentally diminished in weakness in dynamic and inactive intercession and dynamic control bunches at 4 and two months (p < 0.05). Be that as it may, this investigation still has some confinement, for example, little comfort test; no depiction of what control gather got; weariness scores just direct preceding mediation; unfit to decide possibility of various position changes amid dialysis session to suit intercession; vague how operational zed stationary versus dynamic gatherings at gauge.

Yurtkuran and associates (2007) investigated an altered yoga-based exercise program in hemodialysis patients by utilizing RCT. The length of the mediation was three months, and yoga-based exercise was completed 30 minutes/day, twice per week. In this examination utilized visual simple scales (VAS) for measuring exhaustion. The program was done in the standing, sitting and lying positions. The program included unwinding procedure (standing position and moderate cadence facilitated with breathing) and stances (chest development, triangle, finish breathing, side twist, standing stomach lift, back quality and half-grasshopper). All patients were given a dynamic scope of movement exercise to accomplish for 10 minutes at home.The scientists found that scope of movement practices at home brought about fundamentally diminished weariness levels when contrasted with taking part in scope of movement practices as it were. The qualities of this investigation is utilized RCT. Nonetheless, this examination has some confinement, for example, little accommodation test; impact of gathering association as a confounder and misty about planning of mediation.

Using the quasi experimental approach Malagoni and colleagues (2008) explored the long-term and acute impacts of the prescribed dialysis exercise program both in hospital and at home. The study had a population of 31 HD patients. The interventions in the exercise program included 2daily, tem minutes walking home sessions. This happened during the non-dialysis days and involved a speed of 50% lower than the maximal treadmill speed as determined and indicated at the hospital during the first, second, third as well as the fourth month. Intervention consisted of an exercise program of a 10 minute walking session conducted twice a day. This was to be conducted during the non-dialysis days. The speed of the walking sessions was equivalent to 50% below maximum treadmill speed. This was in accordance to the updated at 1, 2, 3,and 4 months at the hospital. Using SF-36, 8 subscale scores (HRQOL) and self-reported post dialysis fatigue measured at 6 months (end of intervention) and 19 ± 3 months post-intervention on non-dialysis days. The results indicated that fatigue was effectively lessened by the home exercise program of walking for ten minutes two times a day (Malagoni et al., 2008).Longitudinal follow up served as the merit point of this study. Nevertheless, there was usage of a small convenience sample in the study. Further, the study was devoid of testing measures and discussion of translation.

In the case of dialysis patients who are relatively healthy, there are varied types of physical activities that they can be engaged in for purposes of diminishing fatigue. Owing to differences in patient demographics, physical limitations as well as issues to do with measurements it becomes intricate to determine which dialysis patients require a certain type of activity and duration in a bid to have maximum decrease of fatigue in them.

2.2 Alternative therapies

Besides dialysis-related variables and physiologic intervention there are several alternative therapies that have been successfully employed in the quest to diminish fatigue in patients that are on hemodialysis.

According to Cho and Tsay (2004) fatigue can be effectively diminished through acupressure and massage to patients with kidney failure and using RCT to receive HD. The study population in this case was 62. the intervention included received a massage with acupressure for 12 minutes and 3 minutes lower limb massage during dialysis. There was a study control group that received the regular care. This kind of intervention prevailed for twelve weeks. The study results indicated that fatigue was significantly diminished by acupressure and massage on the sample patients that were in hemodialysis in Taiwan. The study’s strength was usage of RCT but its weakness was utilization of a petite convenience sample.

Kim and colleagues (2011) sought to investigate the safety, merits and feasibility of acupuncture un managing symptoms of patients receiving HD. To this end, they employed the quasi-experimental research approach with a pretest, pots test as well as one group design and had a study population of 24. The intervention was characterized by a 45 to 60 minute session performed two times a week prior to dialysis days or during the non-dialysis days. The researchers used the Kidney Disease Quality of Life- Short Form (KDQOL-SF) in measuring. Measurements were taken during the seventh and eleventh week of intervention. The results indicated that at week 7 there was significant improvement in reduction of fatigues, enhanced emotional well-being and physical function when contrasted to the baseline kidney disease specific QOL subscales. Further, during the eleventh week there were significant improvements in fatigue reduction and physical function.

A different study sought to examine the impact of FIR on the fatigue levels of HD patients by using the far infrared rays (FIR) acupuncture point. The study had a population of 61 respondents who underwent the intervention exercise for two months. The intervention program entailed a self administered FIR acupuncture point treatment to 4 points for a period of thirty minutes thrice a week. Fatigue was measured using the Brief Fatigue Inventory (BFI, Taiwan Form) –globalas well as subscale scores. The study results indicated during the past week of intervention the NFI subscale score for fatigue had significantly reduced. The reduction in fatigue was also noted in the control group. However, when contrasted the intervention group had significantly lower fatigue score s that the control group. Some of the study limitations were lack of clarity on the time when intervention occurred as well as utilization of a small convenience sample.

Su and colleagues (2009) investigated the impact of FIR acupressure point stimulation when contrasted to heat pad therapy on heart rate variability (HRV) on the quality of life of patients suffering from failure of the kidney. The intervention was characterized by three 30-minutes intervals of FIR in a week. Notably, the control group has similar intervals of heat pad therapy. The study results indicated that compared to heat pad therapy, there effective fatigue reduction when using the far infrared acupressure point stimulation in hemodialysis patients. The study limitations were ambiguity in when intervention occurred and a small convenience sample.

Stanley, Leither and Sindelir (2011) provided a different therapy for diminishing fatigue by using a holistic breathing technique that comprised of slow breathing exercises whilst concentrating on moving air in and out of the chest. The Kidney Disease Quality of Life Instrument was used to measure fatigue and variables in quality of life prior to teaching the patients on the breathing technique. The tool was not re-administered after the intervention with limitation of time being cited as the reason. The researchers instead asked the respondents if the breathing intervention had been of help to them (Stanley et al., 2011).

The success of interventions is difficult to speculate in all countries across the globe. This is because success is at times dependent on the culture and context of the countries. Alternative therapies are potentially viable when compared to physiologic exercise and supplementation in the quest to manage fatigue among patients undergoing dialysis. Nonetheless, there is need for these alternative options to be supported in literature in respect to the regimen and dosage required for them to be effective. In a context where western medicine is perceived as the golden standard the administration of these treatments may be intricate. To enhance their administration there is need for longitudinal studies to investigate the decay and dosage of these interventions in a bid to advance the science behind these alternative therapies.