Delayed post-dialysis recovery times are associated with relative changes in intracellular and extracellular fluid ratios between different body compartments

Introduction: Hemodialysis patient groups have advocated reducing dialysis fatigue and symptoms. We investigated whether compartmental fluid shifts were associated with peri-dialytic fatigue and symptoms. Methods: Sessional dialysis records of patients reporting both a short and delayed recovery (<1 h and >= 1 h) with corresponding bioimpedance measurements were reviewed. Results: One hundred and twenty-four patients reported both short and delayed recovery times, mean age 66.0 +/- 14.8 years, 66.1% male. Differences between sessions included higher distress thermometer [4 (1-6) vs. 3 (0-5)], fatigue [4 (0-9) vs. 2 (0-7)], total symptom scores [20.5 (12.3-34.5) vs. 16 (7-28)], change in extracellular water to total body water ratios between body compartments [right leg/left arm 2.36 (1.23-4.19) vs. 1.28 (0.12-2.01), all p < 0.01] with delayed recovery, and more hemodialysis than hemodiafiltration sessions (chi(2) 4.6, p = 0.02). Conclusion: Sessions with prolonged recovery times were associated with more peri-dialytic symptoms, psychological distress, and hemodialysis mode, and greater changes in compartmental fluid shifts.