Prevalence and influencing factors of fatigue among patients undergoing continuous ambulatory peritoneal dialysis: A cross-sectional study


social support
continuous ambulatory peritoneal dialysis
body mass index
functional status

How to Cite

Maninet, S., Nakrit, B., & Suttavat, P. (2023). Prevalence and influencing factors of fatigue among patients undergoing continuous ambulatory peritoneal dialysis: A cross-sectional study. Belitung Nursing Journal, 9(4), 391–398.
Google Scholar

Link to Google Scholar

Accepted for publication: 2023-08-08
Peer reviewed: Yes

Related articles in

Search Relations - Article by Author(s)

Share this article on:


Background: Fatigue is one of the most commonly reported symptoms among patients undergoing continuous ambulatory peritoneal dialysis (CAPD). However, only a few studies have addressed the prevalence of fatigue and its influencing factors within this population in Thailand.

Objective: This study aimed to explore the prevalence of fatigue and its influencing factors, including duration of CAPD initiation, body mass index, insomnia, social support, functional status, and depression among patients undergoing CAPD.

Methods: This cross-sectional study involved 136 participants from the outpatient department of a general hospital in Thailand. Data were collected from January to March 2023, utilizing validated self-reported questionnaires, which included the Center for Epidemiologic Study Depression Scale, Insomnia Severity Index, Multidimensional Scale of Perceived Social Support, Functional Status Scale, and Fatigue Severity Scale. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation, and Stepwise multiple regressions.

Results: The study achieved a 100% participation rate among the selected participants. The prevalence of fatigue among patients undergoing CAPD was 55.88%, including mild fatigue (20.59%), moderate fatigue (19.85%), and severe fatigue (15.44%). Bivariate analysis indicated that fatigue-related factors were insomnia, depression, body mass index, social support, and functional status. However, the multiple regression analysis revealed that only insomnia (β = 0.399, p <0.001), social support (β = -0.302, p <0.001), depression (β = 0.201, p = 0.003), and functional status (β = -0.149, p = 0.021) jointly influenced fatigue among patients undergoing CAPD, explaining 50.10 percent of the variance (R2 = 0.501, F(4, 131) = 32.871, p <0.001).

Conclusion: The findings indicated that more than half of the participants experienced fatigue. Insomnia, social support, depression, and functional status emerged as significant predictive factors of fatigue. Therefore, it is advisable for nurses and other healthcare providers to evaluate fatigue and its associated factors routinely. Nursing interventions to alleviate fatigue should prioritize improvements in sleep quality, reduction of depression, preservation of functional status, and promotion of family engagement.


Copyright (c) 2023 Surachai Maninet, Bangaorn Nakrit, Phasuk Suttavat

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Article Metrics

Total views 260 [Abstract: 131 | PDF: 129 | XML: 0 ]


Download data is not yet available.

PlumX Metrics

Declaration of Conflicting Interest

The authors declared no potential conflict of interest in this study.


The authors sincerely thank the entire staff of the chronic kidney disease clinic at Nakhon Nayok Hospital, Thailand, for their support throughout the research study. Heartfelt appreciation is also directed towards the experts who provided invaluable insights and guidance during the validation process of the research instruments. Most importantly, the authors sincerely appreciate the patients undergoing continuous ambulatory peritoneal dialysis, whose voluntary participation in the research activities made this study achievable.

Authors’ Contributions

SM contributed to the conception of the study, literature search, data analysis and interpretation, drafting and writing the manuscript, and overall supervision. BN and PS contributed to the conception of the study, data collection, and drafting of the manuscript. All authors contributed to the critical revision of the manuscript and approved the submitted and published versions.

Data Availability

The dataset generated during and analyzed during the current study is available from the corresponding author upon reasonable request.

Declaration of Use of AI in Scientific Writing

Nothing to declare.


Abd-Rabouh, M., Abd Elhameed, S., & Shebl, A. (2017). Relationship between fatigue and functional status of the elderly patients on Hemodialysis. Mansoura Nursing Journal, 4(2), 83-96.

Al Naamani, Z., Gormley, K., Noble, H., Santin, O., & Al Maqbali, M. (2021). Fatigue, anxiety, depression and sleep quality in patients undergoing haemodialysis. BMC Nephrology, 22(1), 157.

Almutary, H., Bonner, A., & Douglas, C. (2016). Which patients with chronic kidney disease have the greatest symptom burden? A comparative study of advanced CKD stage and dialysis modality. Journal of Renal Care, 42(2), 73-82.

Avdal, E. U., Ayvaz, İ., Uran, B. N. Ö., Yildirim, J. G., Sofulu, F., & Pamuk, G. (2020). Opinions of hemodialysis and peritoneum patients regarding depression and psychological problems which they experience: A qualitative study. Journal of Infection and Public Health, 13(12), 1988-1992.

Bagheri-Nesami, M., Shorofi, S. A., Nikkhah, A., Espahbodi, F., & Koolaee, F.-S. G. (2016). The effects of aromatherapy with lavender essential oil on fatigue levels in haemodialysis patients: A randomized clinical trial. Complementary Therapies in Clinical Practice, 22, 33-37.

Bastien, C. H., Vallières, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297-307.

Brys, A. D. H., Di Stasio, E., Lenaert, B., Sanguinetti, M., Picca, A., Calvani, R., Marzetti, E., Gambaro, G., & Bossola, M. (2020). Serum interleukin-6 and endotoxin levels and their relationship with fatigue and depressive symptoms in patients on chronic haemodialysis. Cytokine, 125, 154823.

Gao, Y., Shan, Y., Jiang, T., Cai, L., Zhang, F., Jiang, X., Li, X., & Wang, H. (2021). Dietary adherence, self-regulatory fatigue and trait self-control among chinese patients with peritoneal dialysis: A cross-sectional study. Patient Preference and Adherence, 15, 443-451.

Garwai, H. M., Abdulmutalib, I. A. M., & Mohammed, A. H. (2020). The relationship between social support and fatigue severity among hemodialysis patients. American Journal of Nursing Research, 8(3), 392-398.

Guedes, M., Wallim, L., Guetter, C. R., Jiao, Y., Rigodon, V., Mysayphonh, C., Usvyat, L. A., Barretti, P., Kotanko, P., & Larkin, J. W. (2022). Fatigue in incident peritoneal dialysis and mortality: A real-world side-by-side study in Brazil and the United States. PloS One, 17(6), e0270214.

James, G., Nyman, E., Fitz-Randolph, M., Niklasson, A., Hedman, K., Hedberg, J., Wittbrodt, E. T., Medin, J., Moreno Quinn, C., & Allum, A. M. (2020). Characteristics, symptom severity, and experiences of patients reporting chronic kidney disease in the PatientsLikeMe online health community: Retrospective and qualitative study. Journal of Medical Internet Research, 22(7), e18548.

Jhamb, M., Abdel-Kader, K., Yabes, J., Wang, Y., Weisbord, S. D., Unruh, M., & Steel, J. L. (2019). Comparison of fatigue, pain, and depression in patients with advanced kidney disease and cancer—symptom burden and clusters. Journal of Pain and Symptom Management, 57(3), 566-575.

Joshwa, B., & Campbell, M. L. (2017). Fatigue in patients with chronic kidney disease: Evidence and measures. Nephrology Nursing Journal, 44(4), 337-344.

Keawphang, P., & Jitpanya, C. (2004). Relationships between selected factors and insomnia in adult cancer patients [Unpublished master's thesis, Chulalongkorn University]. Bangkok, Thailand.

Kim, S. J., Kim, S., Jeon, S., Leary, E. B., Barwick, F., & Mignot, E. (2019). Factors associated with fatigue in patients with insomnia. Journal of Psychiatric Research, 117, 24-30.

Krupp, L. B., LaRocca, N. G., Muir-Nash, J., & Steinberg, A. D. (1989). The fatigue severity scale: Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46(10), 1121-1123.

Lau, S. C. L., Baum, C. M., Connor, L. T., & Chang, C.-H. (2023). Psychometric properties of the Center for Epidemiologic Studies Depression (CES-D) scale in stroke survivors. Topics in Stroke Rehabilitation, 30(3), 253-262.

Lenz, E. R., Pugh, L. C., Milligan, R. A., Gift, A., & Suppe, F. (1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14-27.

Liu, G.-L., Zhan, Q.-N., Zhao, Y.-L., Xiong, Z.-Y., Liao, J.-L., Ren, Y.-P., Wang, Q., Duan, L.-P., Zheng, Z.-X., & Hao, L. (2021). Risk factors for sleep disorders in patients undergoing peritoneal dialysis. Sleep and Biological Rhythms, 19, 255-264.

Maninet, S., & Desaravinid, C. (2023). Relationships between illness perception, functional status, social support, and self-care behavior among Thai people at high risk of stroke: A cross-sectional study. Belitung Nursing Journal, 9(1), 62-68.

Maruyama, Y., Nakayama, M., Ueda, A., Miyazaki, M., & Yokoo, T. (2021). Comparisons of fatigue between dialysis modalities: A cross-sectional study. PloS One, 16(2), e0246890.

Modesto, A. P., Usvyat, L., Calice-Silva, V., Spigolon, D. N., Figueiredo, A. E., de Moraes, T. P., Olandoski, M., Shimakura, S. E., Barreti, P., & Kotanko, P. (2018). Impact of the Karnofsky performance status on survival and its dynamics during the terminal year of peritoneal dialysis patients. Peritoneal Dialysis International, 38(1), 24-29.

Ploylearmsang, C. (2005). Construct validity of the CES-D depression scale among students. Isan Journal of Pharmaceutical Sciences, 1(1), 25-39.

Polsingchan, S., & Rungruang, K. (2022). Factors affecting resilience quotient of end stage renal disease patients receiving continuous ambulatory peritoneal dialysis [in Thai]. Nursing Journal of The Ministry of Public Health, 32(2), 78-91.

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401.

Ream, E., & Richardson, A. (1996). Fatigue: A concept analysis. International Journal of Nursing Studies, 33(5), 519-529.

Sawasdee, A., Preechawong, S., & Jitpanya, C. (2014). Factors associated with fatigue in post-stroke patients [Unpublished master's thesis, Chulalongkorn University]. Bangkok, Thailand.

Shah, S., Leonard, A. C., & Thakar, C. V. (2018). Functional status, pre-dialysis health and clinical outcomes among elderly dialysis patients. BMC Nephrology, 19(100), 1-14.

Shumaker, S. C., Frazier, S. K., Moser, D. K., & Chung, M. L. (2017). Psychometric properties of the multidimensional scale of perceived social support in patients with heart failure. Journal of Nursing Measurement, 25(1), 90-102.

Tan, L.-H., Chen, P.-S., Chiang, H.-Y., King, E., Yeh, H.-C., Hsiao, Y.-L., Chang, D. R., Chen, S.-H., Wu, M.-Y., & Kuo, C.-C. (2022). Insomnia and poor sleep in CKD: A systematic review and meta-analysis. Kidney Medicine, 4(5), 100458.

Thangarasa, T., Imtiaz, R., Hiremath, S., & Zimmerman, D. (2018). Physical activity in patients treated with peritoneal dialysis: A systematic review and meta-analysis. Canadian Journal of Kidney Health and Disease, 5, 2054358118779821.

Tian, C., Zhang, B., Liang, W., Yang, Q., Xiong, Q., Jin, Q., Xiang, S., Zhao, J., Ying, C., & Zuo, X. (2020). Fatigue in peritoneal dialysis patients and an exploration of contributing factors: A cross-sectional study. Journal of Pain and Symptom Management, 59(5), 1074-1081.

van der Borg, W. E., Verdonk, P., de Jong-Camerik, J. G. A., Schipper, K., & Abma, T. A. (2021). A continuous juggle of invisible forces: How fatigued dialysis patients manage daily life. Journal of Health Psychology, 26(6), 917-934.

Wang, S.-Y., Zang, X.-Y., Fu, S.-H., Bai, J., Liu, J.-D., Tian, L., Feng, Y.-Y., & Zhao, Y. (2016). Factors related to fatigue in Chinese patients with end-stage renal disease receiving maintenance hemodialysis: A multi-center cross-sectional study. Renal Failure, 38(3), 442-450.

Wongpakaran, T., Wongpakaran, N., & Ruktrakul, R. (2011). Reliability and validity of the multidimensional scale of perceived social support (MSPSS): Thai version. Clinical Practice and Epidemiology in Mental Health: CP & EMH, 7, 161-166.

Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., & Berkoff, K. A. (1990). Psychometric characteristics of the multidimensional scale of perceived social support. Journal of Personality Assessment, 55(3-4), 610-617.

Readers are able to give us their valuable feedbacks here. The comments will be reviewed by the editors and then published here. Important Note: The "Comments" related to the Galley Proof PDF must NOT be submitted via this form. Authors should submit their comments on their galley proofs only via system