Fig. 7

Summary of relationships among Enriched metabolite sets (metabolic pathways) (Top 25) of respective patients-sets and inferred pathophysiology of fatigue mechanism. FS: Comparison between fatigue and non-fatigue groups at baseline (M0) with the standard dialysis. EHD: Comparison between S-HD and E-HD (M0 vs. M12). FE: Comparison between fatigue and non-fatigue groups at months 12 (M12) with the electrolyzed water dialysis. S-HD: standard hemodialysis, E-HD: electrolyzed water hemodialysis. There were 16 metabolite sets (metabolic pathways) common to both FS and EHD (i), and 12 metabolite sets common to both FS and FE (iii). Among (i), eight metabolite sets were found to be common with (ii) (Pathway A), and 8 sets with (iii) (Pathway B), respectively. Pathway A may be fatigue-related factors corrected by E-HD, while Pathway B may be fatigue-related factors affected by E-HD, but not corrected enough to reduce fatigue. Among (iii), the 4 metabolite sets which did not overlap (i), may be common phenomenon to fatigue pathologies unaffected by E-HD (Pathway C). Finally, the 13 sets (iv) may represent fatigue factors not affected by E-HD (Pathway D).