Stressful Conditions Increase Fatigue during Undergoing Hemodialysis

Hemodialysis is a therapy given to replace kidney function. This therapy has various physical and psychological impacts on the sufferers. This study aims to analyze stress conditions with fatigue in patients undergoing hemodialysis. Analytic observation research design with a cross-sectional approach. Population of chronic renal failure patients undergoing hemodialysis. The sample was 54 patients, with a non-random sampling technique, with inclusion criteria, namely routine


INTRODUCTION
Progressive kidney damage that occurs in patients with chronic kidney disease, can result in death because the body is unable to maintain metabolism and fluid and electrolyte balance, causing azotemia (Diyono and Mulyanti, 2019) 2023).

Hemodialysis has various effects on patients
with CKD who undergo it, and usually, up to 80% of patients undergoing hemodialysis experience fatigue (Artom et al., 2014;Picariello et al., 2017;Bossola et al., 2023) Fatigue is weakness and decreased energy that is felt subjectively and unpleasant.This

RESULTS AND DISCUSSION
The results of the analysis are presented in the form of descriptions of age, gender, education, length of hemodialysis, stress, and fatigue.2011).This condition has many physical and psychological impacts including stress.
From the results in Table 3, it is found that there is a significant relationship between stress and fatigue (p=0.048).This relationship is weak (r=0.270) and positive, meaning that an increase in stress scores will increase fatigue scores.
with hemodialysis can be caused by changes in life because patients must depend on dialysis machines, undergo routine dialysis processes, changes in health status, and face unstable economic conditions.These changes are stressors for kidney failure patients undergoing dialysis(Gerogianni and Babatsikou, 2014;Canaud et al., 2021).The condition of chronic renal failure itself has a wide range of effects including dialysis therapy, complications in the heart, blood vessels, reproduction, skin, anemia, and musculoskeletal, and almost the entire system has changed.This condition has also given me a feeling of anxiety and stress in dealing with the reality of chronic renal failure(Bezerra, Silva and Elias, 2018) The role of nurses is crucial in managing and overcoming the problems caused by hemodialysis therapy by paying attention to all aspects of physical, psychological, social, and cultural factors(Loenggogeni,   2023; Suriani, Neherta, and Sari, 2023).Therefore, in this study, we examine the extent of the relationship between the two stress variables and fatigue.METHODThe design used was analytic observational with a cross-sectional approach.Data collection was carried out in the hemodialysis room of a hospital in Palembang City on 54 respondents.Sampling was done using non-random sampling, with inclusion criteria, being patients with CKD who have undergone hemodialysis at least twice (1 week), with dialysis frequency of twice a week, full consciousness, ability to communicate well, and signed informed consent.Exclusion criteria included complications during hemodialysis and hearing loss.Data collection was done using interview techniques.The research instrument used the FACIT-Fatigue Scale to measure fatigue scores, with high validity (Cronbach alpha 0.96) and reliability (ICC 0.95) (Tennant, 2019) and the Indonesian version of the Depression Anxiety Stress Scale (DASS 42), with satisfactory reliability (0.806-0.917) for the measurement of stress scores (Muttaqin and Ripa, 2021).The data in this study were analyzed using the Independent T-test and the Pearson Correlation test.

Fatigue
describes the subjective feelings that individuals have, and this is influenced by other factors, one of which is psychological factors including depression, anxiety, and stress (Prastiwi, Wihastuti and Ismail, 2021) dan stress (Picariello et al., 2017).Stress conditions are associated with fatigue in patients with CKD who undergo hemodialysis (García-Llana et al., 2014; Picariello et al., 2017; Sulistni, Damanik and Lukman, 2021).Stress can affect fatigue through various physiological mechanisms.The hormone cortisol increases under stressful conditions, causing changes in blood circulation, heart rate, and blood pressure.This condition drains the body's energy resulting in fatigue.(Harrington, 2013).Stress in patients undergoing hemodialysis is usually due to daily restrictions, tension from dependence on hemodialysis machines, loss of self-esteem, uncertainty about the future, and feelings of guilt towards the family.(Kang and Chae, 2021).Another parallel study by Sari (2019) states that patients undergoing dialysis can experience severe stress, reaching 25%, and shows a relationship between fatigue and stress in patients undergoing hemodialysis therapy.(Kocalevent et al., 2011).Therefore, researcher assumes that as the stress score increases in patients undergoing hemodialysis, the fatigue score also increases.Patients who experience stress during hemodialysis therapy cause fatigue, even though the results of the analysis (r = 0.270) show that the relationship between the two variables is weak.However, there is an opinion that stress and fatigue form a mutually reinforcing cycle.Stress causes a person to experience fatigue, which leads to a decrease in work productivity, further increasing stress.Comprehensive physical and psychological care is needed in treating patients undergoing hemodialysis.In the Hemodialysis Unit, nurses performing nursing care can add educational interventions and provide psychological support (Parvan et al., 2015), and develop stress management and relaxation techniques (Sultan et al., 2023).

Table 3 .
Correlation between Stress and Fatigue (N 54)