Conservation Energy Management on Fatigue in Hemodialysis Patients: A Literature Review

Background: Fatigue is a frequent complaint experienced by patients undergoing hemodialysis, potentially reducing their participation in daily activities. Conservation energy management is proposed as an effective approach to reduce fatigue in hemodialysis patients. Objective: This study aimed to evaluate the effect of conservation energy management on fatigue in hemodialysis patients through a literature review. Methods: This article is a literature review of research articles selected through searching three electronic databases, namely Science Direct, Wiley, and PubMed. The keywords used included 'conservation energy management', 'fatigue', and 'hemodialysis'. Inclusion criteria were English-language articles published within the last five years, focusing on quantitative research, involving adult samples, relevant full-text articles, and original articles. Results: There were five articles that met the inclusion criteria. The findings showed that a conservation energy management program can reduce fatigue and improve quality of life in patients undergoing hemodialysis. Conclusion: This study found that conservation energy management can be effective in reducing fatigue in hemodialysis patients.


INTRODUCTION
Chronic kidney disease (CKD) is an increasing global health problem, and hemodialysis is the primary therapy for patients with end-stage renal disease (ESRD) (1).Hemodialysis, although essential for patient survival, is often accompanied by various complications that impair quality of life, one of which is fatigue (2).Fatigue in hemodialysis patients not only causes a decrease in energy and vitality but also impacts the patient's ability to participate in daily activities, interact socially, and maintain optimal mental and physical health (3).Fatigue in patients undergoing hemodialysis is a multidimensional phenomenon caused by a combination of physiological, psychological, and social factors (4).Factors such as uremic toxin accumulation, anemia, malnutrition, and chronic inflammation can exacerbate fatigue.On the other hand, emotional instability, anxiety, depression, and limited social support also play an important role in aggravating this condition (5).Given the complexity of the causes of fatigue, a comprehensive management approach is necessary to improve the quality of life of patients (6).Conservation energy management is one of the intervention approaches that is gaining attention in addressing fatigue in hemodialysis patients (7).This approach aims to help patients manage and utilize • Email: editor@ijfmr.com

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Volume 6, Issue 4, July-August 2024 2 their energy more efficiently, so that they can carry out their daily activities without experiencing excessive fatigue.The intervention involves educating patients on energy-saving techniques, scheduling activities, and providing advice on adequate rest and stress management (8).

OBJECTIVE
This study aims to evaluate the effect of conservation energy management on fatigue in hemodialysis patients through a literature review.

METHODS
This article is a literature review that summarizes and analyzes the results of related research articles.The literature search was conducted using three major electronic databases: Science Direct, Wiley, and PubMed, using the keywords "conservation energy management" AND "fatigue" AND "hemodialysis".

Effect of Conservation Energy Management on Fatigue
Conservation energy management is effective in reducing fatigue in hemodialysis patients (9).The intervention programs implemented in this study showed that participants undergoing conservation energy management experienced significant reductions in fatigue severity and frequency (10).Farragher et al. (2022) reported that an energy management program can reduce fatigue and improve life participation in patients undergoing hemodialysis (9).This finding is supported by Bossola et al. (2011) who found that energy management strategies helped patients better manage their fatigue symptoms (11).In addition, Jhamb et al. (2019) confirmed that fatigue reduction through energy management contributes to increased participation in daily activities and improved overall quality of life (12).

Improved Quality of Life
Conservation energy management focuses not only on reducing fatigue, but also on improving the quality of life of patients.Sharma et al. (2021) reported that participants in this program showed significant improvements in various aspects of quality of life, including physical, psychological, and social functioning (7).Education and intervention programs provide patients with the understanding and skills to manage their energy more effectively, which in turn improves their ability to cope with daily activities better (6,13).Motzer and Hertig (2004) found that significant improvements in quality of life were achieved through structured interventions and ongoing support in energy management in hemodialysis patients (14).In addition, Barsevick et al. (2004) showed that energy management is effective in reducing fatigue and improving quality of life in cancer patients, which can be applied to the context of hemodialysis patients (15).

Program Implementation Strategy
Different approaches in implementing conservation energy management programs have been identified.Some studies used a randomized controlled trial (RCT) design with repeated measurements, while others used a quasi-experimental design with pretest and posttest.The results of these studies consistently show the effectiveness of conservation energy management in reducing fatigue and improving the quality of life of hemodialysis patients.Farragher et al. ( 2021) reported that a community-based intervention program for energy management in hemodialysis patients provided significant results in improving patients' quality of life (16).In addition, Farragher et al. (2020) found that an energy management program implemented in hemodialysis patients can improve physical performance and reduce fatigue (8).

Educational Intervention
Energy conservation education is an important component of a conservation energy management program (17).Educational interventions help patients understand the importance of saving energy and teach techniques that can be applied in daily life (7).Reza et al. (2022) showed that participants who received energy conservation education reported increased knowledge and skills in energy management, which had a positive impact on their well-being (10).This education includes knowledge on how to organize rest periods, use assistive devices, and apply other techniques to reduce fatigue.Energy management education programs can improve patients' self-efficacy in managing fatigue (6).Overall, the findings from this literature review support that conservation energy management is an effective approach in reducing fatigue and improving quality of life in hemodialysis patients.Implementation of this program in clinical practice can help patients better manage their fatigue symptoms, increase participation in daily activities, and improve overall well-being.Therefore, it is recommended to integrate conservation energy management into routine care for hemodialysis patients to achieve optimal health outcomes.

CONCLUSIONS
The conclusion of this review suggests that conservation energy management interventions are effective in reducing fatigue and improving the quality of life of hemodialysis patients.The use of these interventions in clinical practice is recommended, with recommendations for further research focusing on optimizing and customizing conservation energy management programs according to individual patient needs.

Table 1 . Journal Extraction
The search was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol and involved selecting articles based on predefined inclusion criteria.The article search period lasted from January to June 2024.The inclusion criteria in the literature search were as follows: (1) freely accessible English-language articles published within the last five years (2019-2024), (2) studies involving hemodialysis patients, (3) articles using quantitative research methods, (4) articles in full text, and (5) articles that were relevant and original research.The exclusion criteria included articles that did not have a full structure, articles in the form of systematic/literature reviews, and articles with qualitative research methods.From the search, a total of 1,262 articles were found, with 231 articles from the Science Direct database, 4 articles from the PubMed database, and 188 articles from Wiley.After initial screening of