My research is focused on understanding trajectory patterns and factors predict fatigue levels in individuals on hemodialysis treatment. We can develop and optimize interventions once we understand the factors that predict fatigue in these patients.

Program of Research

Dr. Joshwa's program of research centers on understanding fatigue in patients on hemodialysis. Her education in nephrology nursing initiated her interest in individuals with kidney failure and dialysis. Findings from her first original study on patients on dialysis found a high prevalence of multiple symptoms such as fatigue, sleep problems, and depression. Her dissertation research, funded by American Nephrology Nurses Association and Blue Cross Blue Shield Foundation of Michigan student award, provided an understanding of the multiple dimensions and diurnal patterns of fatigue using self-report and physical performance measures in individuals on chronic hemodialysis treatment.

Her doctoral dissertation study focused on fatigue specifically, its multiple dimensions and correlates. In that study, a high prevalence of fatigue was confirmed with multidimensional, objective fatigue assessment measures in an ethnically diverse, powered sample. She demonstrated a successful collaboration with one of the largest dialysis organizations in Southeast Michigan. A variety of other novel findings were established in that study. For instance, that study was the first to determine the safety of six-minute walk test immediately before and after dialysis treatment. The validity and reliability of multidimensional measures for fatigue assessment were confirmed in that study.

Her current research is focused on determining trajectory patterns of fatigue over a period of three consecutive days including one non-dialysis day and two dialysis days. The current study also focuses on examining the bio-behavioral and socio-structural factors that influence fatigue in dialysis populations using repeated measures study design. This current project is being supported by Blue Cross Blue Shield Investigator-Initiated Award, and Ada Jacox Pain and Symptom Management Research Award. Findings from this preliminary study will be used toward optimizing anti-fatigue interventions in the future.

Another secondary research based on data from Chronic Renal Insufficiency Cohort Study is currently underway. This proposal has been accepted by NIDDK recently, and will include identification of symptoms clusters in individuals with kidney disease. Dr. Joshwa has published articles on fatigue including multiple dimensions and correlates of fatigue, evidence and recommendations for fatigue assessment, and prevalence of various symptoms in individuals on hemodialysis.

Current Research

• Joshwa, B. (PI), Yarandi, H., Zimmerman, R.,Jenuwine, E. (2023). Identification of symptom clusters in indivuals with advance kidney disease using CRIC national study datasets.
  • Funding Support: None
• Joshwa, B. (PI), Schutte, D., Malek, M., Yarandi, H., Zimmerman, R., Provenzano, C., Badr. S. (2021). Trajectory Patterns and Factors predicting Fatigue in Individuals on Hemodialysis, June 2021-current.  
  • Funding support: Blue Cross Blue Shield Foundation of Michigan Investigator-Initiated Grant (52,000$); Ada Jacox and Pain Management Award 2022 and 2023 (10,000$)
• Joshwa, B. (PI), Campbell, M. L., Peters, R., Malek. M., Yarandi, H. (2017). Intensity and Correlates of Fatigue in Individuals on Hemodialysis, 11/1/2017-3/30/2019.
  • Funding support: American Nephrology Nurses Association (6000$), Blue Cross Blue Shield Foundation of Michigan Student Award (3000$).

Populations of interests

• Older adults
• Adults
• Individuals with advanced kidney disease

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