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Hemodialysis patients (HD) commonly report fatigue. Muscle wasting (sarcopenia) and extracellular water (ECW) excess have been reported to be associated with fatigue in other conditions. We wished to determine whether muscle loss and ECW excess were associated with fatigue in HD patients. Patients completed the Multidimensional Fatigue Inventory (MFI), Beck Depression Inventory‐II (BDI‐II), Patient Health Questionnaires (PHQ‐9) and recorded their post‐dialysis recovery time. Sessional dialysis data were recorded along with pre‐ and post‐dialysis multi‐frequency bioimpedance assessments (MFBIA). One hundred and ten patients, median age 64 (52–79) years, 67% male, 35% diabetic completed questionnaires and had pre‐ and post‐HD MFBIAs. Median total MFI score was 60 (48–72), with the physical domain having the highest score. Modal (30.8%) recovery time post‐dialysis was 1–4 h. Of the …