Table 2.

Potential multi-disciplinary approaches to improving fatigue in ESRD patients

Targeted area	Interventions
Increase health care provider awareness	• Education of prevalence, importance and severity of fatigue
	• Training at identifying symptoms of fatigue
Improve measurement of fatigue	• Development of criteria for defining fatigue
	• Development of improved fatigue scales specific for this population
	• Use of ecological momentary assessment for measurement of day-to-day and diurnal variation in fatigue
	• Development of improved survey modalities such as telephone interview, computer-assisted interview, and proxy administration of interviews to reduce selection bias
	• Frequent screening for fatigue
Address gaps in understanding pathogenesis of fatigue	• Role of cytokines
	• Mode of dialysis
	• Frequency of dialysis
	• Thermoneutral hemodialysis
Test potential therapies for fatigue in ESRD	Non-pharmacological
	• Nutritional therapy
	• Sleep therapy and sleep hygiene
	• Exercise
	• Stress management
	• Cognitive-behavioral treatment of depression
	• Energy Conservation
	• Acupressure
	• Treatment of substance abuse and dependence
	Pharmacological
	• Hematopoeitics
	• Antidepressants
	• Anxiolytics
	• Levocarnitine
	• Human growth hormone
Improving social support for patients with fatigue	• Family members and care providers education and training
	• Addressing caregiver fatigue