ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: TH-PO312

Fatigue on Hemodialysis Day Is Associated with Post-Hemodialysis Amino Acids Depletion

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Debnath, Subrata, University of Texas Health San Anotonio, San Antonio, Texas, United States
  • O'Connor, Jason, University of Texas Health San Antonio, San Antonio, Texas, United States
  • Bansal, Shweta, University of Texas Health San Antonio, San Antonio, Texas, United States
  • Lorenzo, Carlos, University of Texas Health San Antonio, San Antonio, Texas, United States
  • Sharma, Kumar, University of Texas Health San Antonio, San Antonio, Texas, United States

End-stage renal disease (ESRD) patients on maintenance hemodialysis (HD) endure debilitating fatigue. Kidney function is essential for the synthesis, balance, and interorgan exchange of several amino acids (AA) notably aromatic amino acids (AAA) such as phenylalanine, tyrosine, and tryptophan and branched-chain amino acids (BCAA): leucine, isoleucine and valine. Dysregulation of these AA has been implicated in the genesis of fatigue as they may affect neurotransmitters. The relationship of AA with fatigue in HD patients is not known.


In a cross-sectional study, we examined the relationship between AA and fatigue in a well-characterized cohort of HD patients with T2 diabetes (N=119). The mean±SD age was 54.77±12.76 yr and 48% were female. Mean serum albumin was 3.46±0.38 g/dl, Hgb 11.04±1.43 mg/dl, and HgbA1c 6.93±1.86%. Fatigue on HD day was assessed by the 9-item Brief Fatigue Inventory (BFI) which measures fatigue severity and fatigue impact on daily functioning. BFI has internal consistency coefficient 0.96 and scores range from 0 to 90, lower score = less fatigue. BFI item #3 (Please rate your fatigue that best describes your WORST level of fatigue) was chosen to represent fatigue severity for conceptual simplicity. Free AA in pre- and post-HD plasma were quantified using HPLC-mass spectrometry.


BCAA and AAA levels decreased significantly post HD (p<0.0001 and 0.0009, respectively). Post-HD AA, except for tyrosine, correlated with BFI item #3 and global fatigue scores (mean of all BFI 9 items). On Pearson correlation, post-HD BCAA and AAA levels correlated negatively with worst fatigue (r=−0.24, p=0.015 and r=−0.26, p=0.009, respectively) and global fatigue (r=−0.26, p=0.008 and r=−0.26, p=0.01, respectively). These correlations remained significant after adjustments for HD duration, dialysis shift, and intradialytic changes in body weight and blood pressure. Fatigue intensity, categorized into mild (1-3), moderate (4-6), and severe (≥7) based on BFI item #3 score, inversely related to post-HD AA levels: BCAA (p for trend 0.028) and AAA (p for trend 0.008).


HD procedure depletes BCAA and AAA. Post-HD levels of both BCAA and AAA correlate with fatigue on HD day in ESRD patients. Depleted AA may contribute to impaired neurotransmitters synthesis.


  • Private Foundation Support