Hemodialysis treatment on Quality of Life: assessment of the correlation between reward system and chronic fatigue

Objective: End-stage renal failure, if not addressed in an adequate manner, can lead to death. However, haemodialysis treatment greatly influences the patient's life. Basic research on neuro-immune interactions has demonstrated that an alteration of the basal ganglia function may result in altered reward processes in chronic diseases, such as chronic hemodialysis patients (HD). Moreover, these patients have chronic fatigue, affecting the quality of life (QoL). Fatigue is a symptom, both physical and motivational. This last aspect is often associated with pain, affective and cognitive disorders. The aim of the present study was to investigate a possible correlation between the fatigue and the reward mechanisms that regulate the motivational disposition behaviours in HD patients with a significant impact on QoL. Participants and Methods: Evaluative scales was administered to a sample of middle-aged haemodialysis patients (N=94). Fatigue Severity Scale (FSS) was applied to measure the impact of fatigue on motivation functionality. Behavioural Activation System (BAS) and Behavioural Inhibition System (BIS) Scale was administered to investigate the resulting in approach/avoidance behaviours to rewards. Finally, the State-Trait Anxiety Inventory (STAI-Y) and the Back Depression Inventory (BDI-II) were used to evaluate the presence of anxiety and depression disorders. Results: Results showed a positive correlation between FSS and BDI score. The same for STA-Y score. The FSS score was significantly higher in patients with high BIS Z-score than in patients with low and medium BIS Z-score. Conversely, the BDI score and the STAI-Y1 and STAI-Y2 scores were similar among the high, medium and low BIS Zscore groups of patients. The correlation between the BIS score and the FSS score was statistically significant. Conclusions: This study shows that there is a correlation between fatigue symptoms and reward system with possible consequences on patient’s engagement and QoL.