The Benefit and Safety of Vitamin B Combination to Reduce Fatigue and Improve Quality of Life in Chronic Kidney Disease Patients

  • Rizaldy Taslim Pinzon Bethesda Hospital; Duta Wacana Christian University School of Medicine
  • Rosa De Lima Renita Sanyasi Panti Rapih Hospital
  • Esdras Ardi Pramudita Panti Rapih Hospital


Background: Chronic kidney disease (CKD) patients often have a chronic fatigue and lower QoL, thus may increase morbidity and mortality in CKD patients. Objective: The objective was to identify the benefit and safety of administration of intravenous vitamin B combination to reducing fatigue, measure the prevalence of fatigue and QoL in CKD patients. Method: This study was an observational non control study for 4 weeks in CKD patients with routine hemodyalisis 2 times/week. Every subject has a routine administration of intravenous vitamin B combination, consist of 100 mg vitamin B1, 100 mg vitamin B6, and 5000 mcg vitamin B12, after each hemodyalisis. Visual analogue scale (VAS) used to measure the degree of fatigue. QoL measured using SF-8 questionnaire, consist of total, physical (PCS), and mental component (MCS). Results: The prevalence of fatigue is high. The mean VAS score was 3.4±2.1 at baseline and there were 46.7% subjects with VAS score above the mean VAS score. After 4 weeks administration of vitamin B combination intravenously, the mean VAS score was decreasing from 3.4 to 2.7. The prevalence of fatigue was decreasing from 46.7% to 41%. This shifting was statistically significant (p:0.008). There was a score reduction in total component (20.19±4.8 to 19.29±4.9), PCS (13.44±3.1 to 12.99±3.5), and MCS (6.75±2.1 to 6.31±1.9). This score reduction indicated a better QoL. However, the reduction was not statistically significant. Conclusion: The prevalence of fatigue is high. Intravenous vitamin B combination considered to be effective and safe to reducing the degree of fatigue in CKD patients.

Keywords: chronic kidney disease, fatigue, hyperhomocysteinemia, vitamin B combination, quality of life


Download data is not yet available.


1. Jhamb M, Liang K, Yabes J, Steel JL, Dew MA, Shah N, Unruh M. Prevalence and correlates of fatigue in chronic kidney disease and end-stage renal disease: are sleep disorders a key to understanding fatigue? Am J Nephrol 2013;38:489–495.
2. Cabrera VJ, Hansson J, Kliger AS, Finkelstein FO. Symptom Management of the Patient with CKD: The Role of Dialysis. Clin J Am Soc Nephrol 2017;12:687–693.
3. Abdel-Kader K, Unruh ML, Weisbord SD. Symptom Burden, Depression, and Quality of Life in Chronic and End-Stage Kidney Disease. Clin J Am Soc Nephrol 2009;4:1057–1064.
4. Macdonald JH, Fearn L, Jibani M, Marcora SM. Exertional Fatigue in Patients With CKD. American Journal of Kidney Disease 2012;60(6):930-939.
5. Sakkas GK, Karatzaferi C. Hemodialysis fatigue: just ‘simple’ fatigue or a syndrome on its own right? Front Physiol 2012;3:31.
6. Artom M, Moss-Morris R, Caskey F, Chilcot J. Fatigue in advanced kidney disease. Kidney International 2014;86:497–505.
7. Gordon PL, Doyle JW, Johansen KL. Postdialysis fatigue is associated with sedentary behavior. Clin Nephrol 2011;75:426–433.
8. Zalai D, Bohra M. Fatigue in chronic kidney disease: Definition, assessment and treatment. CANNT J 2016;26(1):39-44.
9. Bossola M, Luciani G, Tazza L. Fatigue and its correlates in chronic hemodialysis patients. Blood Purif 2009;28(3):245-52.
10. Horigan AE. Fatigue in Hemodialysis Patients: A Review of Current Knowledge. Journal of Pain and Symptom Management 2012;44(5):715-724.
11. Awuah KT, Finkelstein SH, Finkelstein FO. Quality of life of chronic kidney disease patients in developing countries. Kidney Int Suppl 2013;3(2):227–229.
12. Tseng BY, Gajewski BJ, Kluding PM. Reliability, Responsiveness, and Validity of the Visual Analog Fatigue Scale to Measure Exertion Fatigue in People with Chronic Stroke: A Preliminary Study. Stroke Res Treat 2010;2010:412964.
13. Tseng BY, Billinger SA, Gajewski BJ, Kluding PM. Exertion Fatigue and Chronic Fatigue Are Two Distinct Constructs in People Post-Stroke. Stroke. 2010;41:2908–2912
14. Nadarajah M, Mazlan M, Abdul Latif L, Goh H. Test-retest reliability, internal consistency and concurrent validity of Fatigue Severity Scale in measuring post-stroke fatigue. European Journal of Physical and Rehabilitation Medicine 2017;53(5):703-9.
15. Yates H, Adamali HI, Maskell N, Barratt S, Sharp C. Visual analogue scales for interstitial lung disease: a prospective validation study. QJM: An International Journal of Medicine 2018;111(8):531–539.
16. Appukuttan D, Vinayagavel M, Tadepalli A. Utility and validity of a single-item visual analog scale for measuring dental anxiety in clinical practice. Journal of Oral Science 2014;56(2):151-156.
17. Diniz LR, Balsamo S, de Souza TY, Muniz LF, Martins WR, da Mota LMH. Measuring fatigue with multiple instruments in a Brazilian cohort of early rheumatoid arthritis patients. Rev. Bras. Reumatol 2017;57(5).
18. Steiber AL, Kopple JD. Vitamin status and needs for people with stages 3-5 chronic kidney disease. Journal of Renal Nutrition 2011;21(5):355-68.
19. Caplin B, Kumar S, Davenport A. Patients’ perspective of haemodialysisassociated symptoms. Nephrol Dial Transplant 2011;26:2656–2663.
20. Zyga S, Alikari V, Sachlas A, Fradelos EC, Stathoulis J, Panoutsopoulos G, Georgopoulou M, Theophilou P, Lavdaniti M. Assessment of Fatigue in End Stage Renal Disease Patients Undergoing Hemodialysis: Prevalence and Associated Factors. Med Arch 2015;69(6):376–380.
21. Brown SA, Tyrer FC, Clarke AL, Lloyd-Davies LH, Stein AG, Tarrant C, Burton JO, Smith AC. Symptom burden in patients with chronic kidney disease not requiring renal replacement therapy. Clinical Kidney Journal 2017;10(6):788–796.
22. Joshwa B, Khakha DC, Mahajan S. Fatigue and depression and sleep problems among hemodyalisis patients in tertiary care center. Saudi J Kidney Dis Transpl 2012;23:729-735.
23. Bonner A, Wellard S, Caltabiano M. Levels of fatigue in people with ESRD living in far North Queensland. J Clin Nurs 2008;17(1):90-8.
24. Leinau L, Murphy TE, Bradley E, Fried T. Relationship between conditions addressed by hemodialysis guidelines and non-ESRD-specific conditions affecting quality of life. Clinical Journal of the American Society of Nephrology 2009;4(3):572–578.
25. O’Sullivan D, McCarthy G. An exploration of the relationship between fatigue and physical functioning in patients with end stage renal disease receiving haemodialysis. J CLin Nurs 2007;16(11C):276-284.
26. Kosmadakis G, Correia EDC, Carceles O, Somda F, Aguilera D. Vitamins in dialysis: who, when and how much?. Renal Failure 2014;36(4):638-650.
27. Jankowska M, Rutkowski B, Debska-Slizien A. Vitamins and Microelement Bioavailability in Different Stages of Chronic Kidney Disease. Nutrients 2017;9:282.
28. Bukhari FJ, Moradi H, Gollapudi P, Kim HJ, Vaziri ND, Said HM. Effect of chronic kidney disease on the expression of thiamin and folic acid transporters. Nephrol Dial Transplant 2011;26(7):2137–2144.
29. Patil RG, Bhosle DG, Malik RAH. Vitamin B12 Deficiency In Chronic Kidney Disease. IOSR Journal of Dental and Medical Sciences 2016;15(9):22-25.
30. Mahajan SK, Aundhakar SC. A Study of the Prevalence of Serum Vitamin B12 and Folic Acid Deficiency in Western Maharashtra. J Family Med Prim Care 2015;4(1):64–68.
31. Rusher DR, Pawlak R. A Review of 89 Published Case Studies of Vitamin B12 Deficiency. J Hum Nutr Food Sci 2013;1(2):1008.
32. Tayyebi A, Savari S, Nehrir B, Rahimi A, Eynollahi B. The effect of Vitamin B12 supplemention on fatigue in hemodialysis patients. Iran J Crit Care Nurs 2013;6(1):39-48.
33. Fukuda S, Koyama H, Kondo K, Fujii H, Hirayama Y, Tabata T, Okamura M, Yamakawa T, Okada S, Hirata S, Kiyama H, Kajimoto O, Watanabe Y, Inaba M, Nishikawa Y. Effects of Nutritional Supplementation on Fatigue, and Autonomic and Immune Dysfunction in Patients with End-Stage Renal Disease: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. PLoS One. 2015; 10(3): e0119578.
34. Bonner A, Wellard S, Caltabiano M. The impact of fatigue on daily activity in people with chronic kidney disease. J CLin Nurs 2010;19(21-22):3006-3015.
35. Cruz MC, Andrade C, Urrutia M, Draibe S, Nogueira-Martins LA, Sesso RCC. Quality of life in patients with chronic kidney disease. Clinics (Sao Paulo). 2011;66(6):991–995.
36. Kefale B, Alebachew M, Tadesse Y, Engidawork E. Quality of life and its predictors among patients with chronic kidney disease: A hospital-based cross sectional study. PLoS One. 2019; 14(2):e0212184.
6 Views | 0 Downloads
How to Cite
Pinzon, R., Sanyasi, R. D. L. R., & Pramudita, E. (2020). The Benefit and Safety of Vitamin B Combination to Reduce Fatigue and Improve Quality of Life in Chronic Kidney Disease Patients. Journal of Drug Delivery and Therapeutics, 10(1), 24-30.