Research Award Recipients

Pilot-Testing "PEP-Lite": An Empowering, Self Guided Fatigue Management Intervention for People on Hemodialysis

Co-applicant(s): Danielle Fox, Istvan Mucsi, Jane Davis, Kevin Yau, Maoliosa Donald, Nancy Verdin

Lay Abstract

Background: Fatigue is one of the most common and disabling symptoms of kidney failure. For people receiving hemodialysis, this fatigue goes far beyond ordinary tiredness; it can make even basic daily tasks exhausting and limit participation in meaningful activities. Despite being recognized as a top concern by patients and clinicians, fatigue remains difficult to treat. It can arise from many sources, including anemia, inflammation, muscle changes, medication effects, and the dialysis process itself. Because of this complexity, existing treatments such as medications, exercise programs, and counseling have produced only modest results. Energy management education offers a new way forward. Instead of trying to eliminate fatigue, it teaches people how to work with their limited energy; how to plan, prioritize, and conserve it for the things that matter most. Similar approaches have improved fatigue and quality of life in conditions such as multiple sclerosis and cancer, yet have rarely been used in kidney care.

In 2018, our team developed the Personal Energy Planning (PEP) program to fill this gap. PEP combines education with personalized coaching from trained facilitators, helping people identify and solve energy-related challenges in daily life. Early research showed that PEP improved people's ability to participate in meaningful activities. However, the need for trained facilitators limited its feasibility in busy dialysis units. To overcome this, we developed PEP-Lite: a self-guided, digital version of PEP that keeps its supportive and empowering spirit but allows people to complete the program independently.

Study Objectives: 1. To evaluate whether PEP-Lite is feasible, acceptable, and easy to use for adults receiving hemodialysis. 2. To explore whether completing the program can help reduce fatigue, promote participation in daily life, and improve quality of life

Methods: We will conduct a pilot study with 30 adults who are receiving maintenance hemodialysis at Toronto General Hospital. Eligible participants must have been on dialysis for at least three months, experience fatigue, and be able to give informed consent. Each participant will complete the PEP-Lite program, which consists of six short online learning modules and a printed workbook. The first three modules introduce energy management strategies such as budgeting energy, setting priorities, and goal setting. Participants then choose three activities they would like to improve, such as cooking, walking, or socializing. Modules four to six help participants analyze how they use their energy, identify inefficiencies, and create “Personal Energy Plans” for their chosen goals. Built-in prompts, reflective questions, and examples guide participants to test and refine their plans. Participants complete one module per week, either at home or during dialysis sessions, at a pace that suits them. The research team will track how many people join the study, how many finish the program, and what participants say about their experience. Before and after using PEP-Lite, participants will fill out short questionnaires about how fatigue affects their daily life and how satisfied they are with their ability to do chosen activities. Within two weeks of finishing PEP-Lite, each participant will take part in a one-on-one interview to share their experiences of what worked well, what was challenging, and how the program affected their energy and activity levels. Researchers will then look at all the information together to understand how well the program worked and how it could be improved for a larger study.

Expected Impact: This study will show whether PEP-Lite can be delivered effectively to people on hemodialysis and whether it helps them better manage fatigue and improve participation in daily life. Results will guide refinements to the program and inform the design of a larger clinical trial. Ultimately, PEP-Lite could offer a practical, scalable tool to help people with kidney failure live more independently and meaningfully.