Asad, Halah Nori, Al-Hakeim, Hussein Kadhem, Moustafa, Shatha Rouf et al. · CNS & neurological disorders drug targets · 2023 · DOI
This study looked at patients with severe kidney disease who need dialysis (a machine that cleans their blood) and found they often experience extreme fatigue and other symptoms similar to ME/CFS, such as muscle pain, sleep problems, and brain fog. Researchers measured various substances in the blood and found that fatigue was linked to anemia (low blood iron), poor nutrition, and certain protein imbalances caused by the dialysis treatment itself. The more dialysis sessions patients needed, the worse their fatigue tended to be.
Understanding how dialysis and specific biochemical pathways trigger severe fatigue and systemic symptoms in kidney disease patients may illuminate similar mechanisms in ME/CFS, particularly the role of protein signaling pathways and mineral/nutritional deficiencies. This work suggests that fatigue in chronic illness may share common biological pathways, offering potential diagnostic biomarkers and therapeutic targets relevant to ME/CFS research.
This study demonstrates association, not causation—elevated copper or low β-catenin may be consequences rather than causes of fatigue. The findings are specific to ESRD patients on hemodialysis and cannot be directly applied to ME/CFS without independent validation. The cross-sectional design cannot establish temporal relationships or determine whether these biomarkers are primary drivers or secondary effects of the disease process.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Asad, Halah Nori, Al-Hakeim, Hussein Kadhem, Moustafa, Shatha Rouf, & Maes, Michael (2023). A Causal-Pathway Phenotype of Chronic Fatigue Syndrome due to Hemodialysis in Patients with End-Stage Renal Disease.. CNS & neurological disorders drug targets. https://doi.org/10.2174/1871527321666220401140747
BibTeX
@article{mecfsatlas-asad-2023-causal-pathway,
author = {Asad, Halah Nori and Al-Hakeim, Hussein Kadhem and Moustafa, Shatha Rouf and Maes, Michael},
title = {A Causal-Pathway Phenotype of Chronic Fatigue Syndrome due to Hemodialysis in Patients with End-Stage Renal Disease.},
journal = {CNS & neurological disorders drug targets},
year = {2023},
doi = {10.2174/1871527321666220401140747},
note = {PubMed: 35366785},
url = {https://www.mecfsatlas.com/evidence/asad-2023-causal-pathway},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/asad-2023-causal-pathway
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