Energy conservation education intervention for people with end-stage kidney disease receiving haemodialysis (EVEREST): A two-arm parallel group study

Abstract

Background

Fatigue is a common symptom in kidney failure and impacts on health-related quality of life. Educational interventions involving energy conservation strategies have effectively reduced fatigue in people with other chronic diseases.

Objective

To evaluate the effectiveness of an energy conservation education intervention for people with kidney failure receiving haemodialysis (EVEREST).

Design

A two-arm parallel group study with haemodialysis shift randomisation.

Methods

Recruitment commenced in April 2022 and included 126 participants receiving haemodialysis who met the eligibility criteria. They were randomised based on haemodialysis shifts. The intervention group received a structured energy conservation education program plus usual care over 12 weeks. The control group received the usual care. The energy conservation education program consisted of three individual face-to-face educational sessions, one booster session, and a booklet. Outcomes were fatigue, other chronic kidney disease (CKD) symptoms, occupational performance, and health-related quality of life. Data were collected at baseline, week 4, week 8, and week 12. Intention-to-treat analysis was used.

Results

Participants who received the energy conservation education program showed a significant reduction in fatigue severity (mean difference [MD] = − 1.88, 95 % confidence intervals [CI] [− 2.36 to − 1.40], p < .001), fatigue interference (MD = -1.52, 95 % CI [− 2.02 to − 1.02], p < .001), number of fatigue days (MD = -1.12, 95 % CI [− 1.60 to − 0.64], p < .001), and percent of day fatigued (MD = -18.47, 95 % CI [− 23.60 to − 13.34], p < .001) at week 8 compared to the control group. At week 12, medium to large effect sizes for fatigue severity (effect size [ES] = 2.37, p < .001), fatigue interference (ES = 1.68, p < .001), number of fatigue days (ES = 0.74, p < .001), and percent of day fatigued (ES = 2.10, p < .001) were observed in the intervention group compared to the control group. Similarly, significant improvements were detected in the CKD symptom (ES = 1.49, p < .001), occupational performance (ES = 1.17, p < .001), and satisfaction with the performance (ES = 1.59, p < .001) in the intervention group compared to the control group. A significant effect was seen for health-related quality of life in the intervention group [physical health (ES = 2.14, p < .001) and mental health (ES = 2.06, p < .001)] at week 12 compared to the control group.

Conclusions

The energy conservation education program was successful in reducing fatigue in the haemodialysis population. This simple approach enabled individuals to improve everyday activities, reduce other CKD symptoms and improve health-related quality of life. Nurses could incorporate the energy conservation education program into routine practice in haemodialysis units.

Registration

The trial was registered in ClinicalTrials.gov (Trial registration ID NCT04360408) on April 23, 2020.

Tweetable abstract

Educational intervention about energy conservation for those on haemodialysis reduced fatigue and improved daily activities and health-related quality of life.