Patient-reported outcome measures for fatigue in patients with chronic kidney disease: a systematic review
Authors:
Hughes, A., Ju, A., Cazzolli, R., Howell, M., Guha, C., Levin, A., Manera, K., Teixeira-Pinto, A., Torrisi, L. G., Wheeler, D. C., Wong, G., Wu, R., and Jaure, A.
Abstract:
OBJECTIVE: Fatigue is a common and debilitating symptom that is associated with an increased risk of mortality, dialysis initiation and hospitalisation among patients with chronic kidney disease (CKD). The aim of this study was to identify the characteristics, content and psychometric properties of patient-reported outcome measures (PROMs) used to measure fatigue in patients with CKD not requiring kidney replacement therapy (KRT).
DESIGN: Systematic review. The characteristics, dimensions of fatigue and psychometric properties of these measures were extracted and analysed.
DATA SOURCES: We searched MEDLINE, Embase, PsycINFO and CINAHL from database inception to February 2023.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: All studies that reported fatigue in patients with CKD stages 1-5 not receiving KRT.
RESULTS: We identified 97 studies (20 (21%) randomised trials, 2 (2%) non-randomised trials and 75 (77%) observational studies). 27 different measures were used to assess fatigue, of which three were author-developed measures. The 36-Item Short Form Health Survey (SF-36) and Kidney Disease Quality of Life - Short Form (KDQOL-SF) were the most frequently used measures (41 (42%) and 24 (25%) studies, respectively). Six (22%) measures were specific to fatigue (Chalder Fatigue Questionnaire, Functional Assessment of Chronic Illness Therapy - Fatigue Scale, Functional Assessment of Cancer Therapy-Fatigue, Fatigue Severity Scale, and author developed Chen & Ku 1998, and Hao et al 2021) while 21 (78%) included a fatigue subscale or item within a broader construct for example, quality of life. Various content domains assessed included tiredness, ability to think clearly, level of energy, muscle weakness, ability to concentrate, verbal abilities, motivation, memory, negative emotions and life participation. Only two measures (Chronic Kidney Disease Symptom Index - Sri Lanka, Kidney Symptom Questionnaire) were developed specifically for CKD, but they were not specific to fatigue. Six measures (Chronic Kidney Disease Symptom Index - Sri Lanka, Functional Assessment of Cancer Therapy - Anemia, Revised Illness Perception Questionnaire, Kidney Symptom Questionnaire, Short Form 6 Dimension and 36-Item Short Form Health Survey) had been validated in patients with CKD not requiring KRT.
CONCLUSION: PROMs used to assess fatigue in patients with CKD vary in content and few were specific to fatigue in patients with CKD not requiring KRT. Data to support the psychometric robustness of PROMs for fatigue in CKD were sparse. A validated and content-relevant measure to assess fatigue in patients with CKD is needed.