Rationale & Objective: Fatigue is a debilitating symptom experienced by patients treated with hemodialysis (HD). The standardized outcomes in nephrology-hemodialysis fatigue (SONG-HD-fatigue) and patient-reported outcome measurement information system (PROMIS-fatigue) instruments have not been used extensively among patients treated with HD. Our study evaluated the psychometric properties and treatment response of these measures compared to the commonly used functional assessment of chronic illness therapy-fatigue (FACIT-F) in HD. Study Design: Technology assisted stepped-collaborative-care was a randomized controlled trial to evaluate the effectiveness of a stepped-collaborative-care intervention for symptom management in HD. Setting & Participants: Participants were adult patients receiving in-center 3-times-weekly maintenance HD at 14 dialysis units. Analytical Approach: We compared the performance of the SONG-HD-fatigue (3 items) and PROMIS-fatigue (7 items) against the FACIT-F (13 items) by evaluating their comparative psychometric performance (known-groups validity, convergent and divergent validity, screening utility, within-patient reliability, and responsiveness to treatment). Results: Among participants (N =160; age 57.8 years, 35% female, 27% Black, and 15 % Hispanic), the median baseline FACIT-F score was 44. Patients experiencing higher baseline fatigue levels demonstrated significantly lower social support, physical function, physical activity, and sleep quality, and increased pain intensity, pain interference, depression, and anxiety. SONG-HD-fatigue and PROMIS-fatigue had similar direction and strength of correlations as FACIT-F with these outcomes. A SONG-HD-fatigue score of 4.5 and a PROMIS-fatigue score of 56.8 corresponded to a FACIT-F score of 30 for screening for clinically significant fatigue. The mean difference between the technology assisted stepped-collaborative-care intervention and control group at the 3-month primary outcome timepoint was significant for the PROMIS-fatigue and FACIT-F measures but not for the SONG-HD fatigue. Limitations: Small sample size Conclusions: SONG-HD-fatigue and PROMIS-fatigue had strong correlations with the validated FACIT-F questionnaire, suggesting that they can be helpful screening measures to identify patients treated with HD with significant fatigue. However, they were not as sensitive in capturing response to treatment. Plain-Language Summary: Fatigue is a debilitating symptom experienced by patients undergoing hemodialysis. The standardized outcomes in nephrology-hemodialysis fatigue and patient-reported outcome measurement information system-fatigue questionnaires had very strong associations with the functional assessment of chronic illness therapy-fatigue questionnaire, suggesting that they can be helpful screening measures to identify patients treated with hemodialysis with significant fatigue. The brevity and ease of administration make them a practical option for screening in busy clinical settings. However, they were not as sensitive in capturing response to treatment.
