The Relationship between Fatigue and Depression in Adults with End-Stage Renal Disease on Chronic In-Hospital Hemodialysis: A Scoping Review

Abstract Context Fatigue and depression are two prominent concerns in patients on in-hospital hemodialysis (IHHD) that have recently been identified as research priorities in the nephrology community. Although they are often reported to co-exist, no synthesis of the literature examining their relationship is available. Objective To characterize the literature on the relationship between fatigue and depression in IHHD patients. Methods A scoping review as described by Arksey and O’Malley was conducted. Seven electronic databases were searched for relevant literature using search terms pertaining to fatigue, depression and in-hospital hemodialysis. Key journals and article reference lists were also hand-searched to identify relevant literature. Articles were examined for relevance, and data were extracted to describe the nature and scope of the literature and to characterize the relationship between fatigue and depression. Findings were grouped thematically, and summarized descriptively. Results and conclusions Current literature on this topic is dominated by cross-sectional studies, which support the existence of an association between fatigue and depression in IHHD patients in various practice settings and subpopulations. Numerous multivariable analyses have been performed which suggest the association remains after adjustment for confounding factors. However, there is generally a dearth of longitudinal or interventional literature to clarify the nature of the relationship over time. Current literature is sufficient to justify routine screening for depression in IHHD patients who present with fatigue. Future research should aim to clarify the nature of the relationship over time in IHHD patients, explore mediators and modifiers of the relationship, and investigate the effects of interventions.