Promoting Excellence : Treatment Protocol for Lethargy in ESRD

Renal Palliative Care Initiative: Treatment Protocol for Lethargy in ESRD

This treatment protocol was created to address and manage symptoms of persistent fatigue and post dialysis fatigue in patients with end stage renal disease.

Clinical Care Tools - Symptom Management

Renal Palliative Care Initiative
Baystate Medical Center
759 Chestnut Street S2669
Springfield, MA 01199

Michael Germain, M.D.
[email protected]

How the grantee used this instrument:
This protocol was made available at the clinics and renal unit nursing stations.

esrd, end stage renal disease, fatigue, lethargy, dialysis, kidney disease, symptom assessment

To use this tool:
You may print and copy this tool for your own use from this site. Please credit source.


  1. Sklar, A, Riesenberg, LA, Silber, AK, Ahmed, W, et al. "Postdialysis fatigue," American Journal of Kidney Disease, 1996; 28:732
  2. Sklar, A, Newman, N, Scott, R, Semenyuk, L, et al. "Identification of factors responsible for postdialysis fatigue." American Journal of Kidney Disease, 1999: 34:464.
  3. Robertson, H, Kaky, N, Gurthrie, M, Cardenas, D, et al. "Recombinant erythropoietin improves exercise capacity in anemic hemodialysis patients." American Journal of Kidney Disease, 1990; 4:325.
  4. Brass, E, Adler, M, Sietsema, M, Hiatt,W, "Intravenous L-Carnitine increases plasma carnitine, reduces fatigue, and may preserve exercise capacity in hemodialysis patients." American Journal of Kidney Disease, 2001; 37:1018
  5. Wuerth, D, Finkelstein, S, Ciarcia, M, Peterson, R, et al. "Identification and treatment of depression in a cohort of patients maintained on chronic peritoneal dialysis." American Journal of Kidney Disease, 2001; 37:1011.
  6. Sobh, M, Hussein, S, Tantawy, A, & Ghoneim, M, "Study of effect of optimization of dialysis and protein intake on neuromuscular function I patients under maintenance hemodialysis treatment." American Journal of Nehprology. 1998; 18:399
  7. Kouidi, EJ. "Central and peripheral adaptations to physical training in patients with end-stage renal disease." Sports Medicine, 2001; 31:651.
  8. Johansen, K, Mulligan, K, & Schambelan, M, "Anabolic effects of nandrolone decanoate in patients receiving dialysis." JAMA 1999; 281:1275.
  9. Breitbart, W, Rosenfeld, B, Kaim, M, & Funesti-Esch, J, "A randomized, double-blind, placebo-controlled trial of psychostimulants for the treatment of fatigue in ambulatory patients with human immunodeficiency virus disease." Archives of Internal Medicine, 2001: 411.

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Posted April 2004

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# BMC14, type:symptom_management

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit for more resources.

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