Answer. Kidney disease can manifest itself in numerous ways. Fatigue and inability to perform your usual activities can be a result of chronic kidney disease (CKD). Basic knowledge of how kidney disease can impact your body’s performance and sense of well-being will help you understand why you feel exhausted.

The kidneys serve several important functions. Primarily, they purify your body of toxic waste products that accumulate as a result of your body’s metabolism. Secondarily, the kidneys control your fluid and chemical balance. Finally, they also produce a hormone, erythropoietin (EPO), which stimulates your bone marrow to manufacture red blood cells. These red blood cells carry oxygen and other vital nutrients to your entire body. Insufficient production of red blood cells results in anemia.

Lack of energy can occur as a result of many reasons in CKD. If the kidney disease is advanced enough, that alone can cause fatigue. The toxins may accumulate in your blood and impact your energy and stamina. This is the point in time when dialysis may become necessary. Dialysis is an artificial means of substituting the purification capability that your own kidneys have lost.  

Chemical disturbances and the inability to eliminate enough salt and fluid from your body may create undue stress on your heart. This could result in congestive heart failure, and also limit your energy level. Many times this can be corrected by diet and fluid modification, as well as the use of diuretics.

Anemia, because of a lack of EPO, is a frequent cause of fatigue associated with CKD. Inability to carry enough oxygen to all vital organs will result in tiredness. Patients can become anemic early in the course of their disease. Fortunately, the anemia associated with kidney disease is often treatable. EPO is synthetically manufactured, and is available for use in those patients with CKD, not yet on dialysis. The drug helps you build red blood cells the same way your body does naturally, which may result in more energy.

Discuss the symptoms you are having with your nephrologist. Explain the fatigue you are experiencing. Cite specific examples of how it impacts your daily routine. The doctor will assess your kidney’s capability of cleansing your blood, your fluid balance, as well as determine if you are anemic. The recommendations may include further restrictions in your diet, as well as continued or increased use of diuretics. In some advanced cases, dialysis may be needed. If you are diagnosed with anemia, and do not yet require dialysis, your doctor may prescribe an EPO treatment for your anemia.

Understanding your condition and asking questions are crucial to getting the care you need. It is important to open the communication lines between you and your doctor or nurse. Ask questions, even those that seem like minor concerns. Do not be afraid to talk with them and discuss how you are feeling. The more your doctor and nurse know about how you feel the better they can help you.  

You can conserve your energy by using some of the following tips: 

• Rest. Sleep more at night and take short naps during the day. Your heart rate slows down more quickly at the start of a rest period and more slowly as you continue to rest. Several short rests give your heart more frequent opportunities to beat more slowly. This helps you conserve your energy.

• Ask for help. Don’t be bashful about asking family and friends to pitch in with things like childcare, shopping, housecleaning or driving.

• Eat a well-balanced diet and keep adequately hydrated. If needed, seek advice from a food or nutrition service to help you plan your diet.

• Take short walks or do some light exercise.

• Move slowly. Remember to get up slowly when sitting or lying down. This helps avoid dizziness.

• Wear loose fitting clothing to make breathing easier; shirts with front zippers or buttons take less energy than pullovers.

• Find time to relax. 

• Effectively manage stress, anxiety and depression by talking to your doctor about the way you feel.

Answer provided by Victor Richards, MD. Dr. Richards is the Medical Director of the West Kendall and South Miami Dialysis Centers in Miami , Florida .

The American Association of Kidney Patients presents Ask the Doctor, an opportunity for readers to submit kidney related health questions to healthcare professionals who specialize in an area of concern. The answers are not to be construed as a diagnosis and therefore, alterations in current healthcare should not occur until the patient’s physician is consulted.

This article originally appeared in the September/October 2003 issue of Kidney Beginnings: The Magazine, Vol. 2, No. 3.

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