Dear Editor,

I read with great interest the article Impact of post-dialysis fatigue and recovery time in chronic patients undergoing hemodialysis treatment: an exploratory observational study ¹ The study by these authors offers a relevant contribution to the understanding of post-dialysis fatigue, one of the most prevalent and debilitating symptoms in people with chronic kidney disease undergoing hemodialysis. The article's title immediately caught my attention, as it addresses the topic of my current research.

The research thoroughly explores the impact of fatigue and recovery time after hemodialysis sessions, highlighting factors previously underestimated both in clinical practice and in the assessment of the well-being of people undergoing treatment.

I would like to propose further reflection on the findings of Kickhöfel et al. ^{( 2} , which highlight the fundamental role of the nursing team in the detection, assessment and intervention on fatigue, emphasizing the need for systematic monitoring of this symptom in the care of the person undergoing hemodialysis. This perspective reinforces that understanding fatigue and post-dialysis recovery time requires structured and continuous nursing action, capable of identifying changes in the patient's well-being early and guiding individualized interventions that mitigate the impact of this phenomenon.

To enrich the discussion, I would also like to highlight the study by Zuo et al. ^{( 3} , which investigated the impact of a holistic, multidisciplinary and non-pharmacological nursing care program, led by nurses, on reducing fatigue in people undergoing hemodialysis. The intervention combined walks, motivational interviews, self-care education, and other non-pharmacological integrative strategies. The study concluded that such interventions can substantially reduce fatigue associated with hemodialysis, demonstrating measurable clinical efficacy.

The article by Zuo et al. ^{( 3} complements the study by Blanco-Mavillard et al. ^{( 1} , demonstrating that non-pharmacological, multidisciplinary, and holistic nursing interventions can significantly reduce physical, mental, and muscular fatigue in people undergoing hemodialysis. While the Blanco-Mavillard study focuses on an exploratory analysis of fatigue and recovery time, Zuo et al. ^{( 3} show, through a randomized clinical trial, that fatigue is a modifiable symptom, presenting robust quantitative results that reinforce the need to systematically intervene on this phenomenon. Furthermore, the integrated care model presented by Zuo can enrich the practical implications of Blanco-Mavillard's work, offering concrete intervention proposals capable of effectively improving the well-being of people undergoing hemodialysis.

The findings of Barra et al. ^{( 4} reinforce the clinical relevance of fatigue in people undergoing hemodialysis, showing that almost all elderly individuals studied (97.7%) experience fatigue frequently directly associated with treatment sessions. These findings complement the study by Blanco-Mavillard et al. ^{( 1} , demonstrating that fatigue is a cross-cutting problem marked by greater vulnerability in advanced age groups, which may be associated with greater symptomatic intensity and prolonged post-dialysis recovery time. Thus, the study by Barra et al. ^{( 4} contributes to broadening the understanding of the factors that influence the practice, reinforcing the importance of considering specific sociodemographic and clinical characteristics in the analysis proposed by Blanco-Mavillard.

Thus, integrating the systematic assessment of fatigue and recovery time into nursing practice is an essential step to optimize care, reduce suffering, and promote the well-being of people with chronic kidney disease undergoing hemodialysis.

This raises the question: how can we transform the assessment of post-dialysis fatigue into a structured and integrated clinical indicator capable of guiding institutional policies and nursing practices focused on the well-being of the person undergoing hemodialysis?