Fatigue (tiredness)

What is fatigue and why do I have it?

Everyone feels tired occasionally. Extreme, on-going tiredness, together with a lack of energy, is often called fatigue. There are lots of reasons why you may experience fatigue with CKD.

If your kidneys are not working well, toxins (waste products) build up in your blood and this can make you feel tired and weak. You may feel more tired as your CKD gets worse and your kidney function drops.

CKD can also lead to a shortage of red blood cells, causing you to be anaemic. If anaemia is not treated, it can result in you feeling more tired than usual and lacking in energy.

If you are receiving haemodialysis, you may find that you feel very tired after the treatment. People describe this as feeling ‘washed out’ or ‘drained’. This can last for a few hours after each session or sometimes longer. It may improve over time as your body gets used to the dialysis.

Poor sleep quality can also cause fatigue, particularly if you have problems falling or staying asleep or if you sleep during the day.

Itching is common in people with kidney disease and can also cause disturbed sleep.

A small number of people suffer from a condition called sleep apnoea, when your breathing stops and starts while you sleep.

Many people with CKD experience restless legs syndrome. This is an uncomfortable or unpleasant feeling in your legs and an irresistible urge to move them. As restless legs syndrome usually occurs in the evenings, it can lead to disturbed sleep as you toss and turn in bed to ease the symptoms. This can make you feel very tired the next day.

Feeling depressed or anxious can also cause sleeplessness and fatigue. For example, you may be having worrying thoughts that keep you awake at night, so you are tired during the day.

What are the symptoms of fatigue?

Fatigue can affect people in different ways. Some of the common symptoms are:

Feeling very tired most days
Feeling that you lack the energy to carry out daily tasks such as getting washed and dressed
Finding it hard to concentrate
Feeling anxious, sad or low in mood
Losing interest in things you usually enjoy
Poor memory

Do I need any tests to confirm fatigue?

It’s important to tell your healthcare team if you are experiencing symptoms of fatigue so that they can work out what might be causing you to feel so tired.

If you are receiving dialysis, blood test results can show if you are having enough treatment, as not having dialysis often enough can result in extreme tiredness.

If your kidney team thinks you might have sleep apnoea, they may refer you to a specialist sleep clinic for tests.

Restless legs syndrome is usually diagnosed by your doctor carrying out a clinical examination and asking questions about the symptoms you are experiencing.

Anxiety and depression can be diagnosed by talking with your healthcare team.

What treatments are available?

If your fatigue is caused by anaemia, this can be treated by medications such as iron supplements or erythropoietin (EPO) injections.

If blood tests show that you are not having enough dialysis, you may need to have more or longer sessions.
Sleep apnoea can be treated by wearing a device at night to improve your breathing.
You may be referred to a psychologist or counsellor who can teach you techniques to improve your sleep.
A counsellor or psychologist may also be able to help you to manage feelings of anxiety and depression.

What can I do to help?

There may not be an obvious cause for your fatigue so it cannot be easily treated. However, you may be able to improve the symptoms by making some small changes to your lifestyle.

If you are prescribed medications to treat anaemia, make sure you take them as instructed.
If you are receiving dialysis, it is important to complete your full dialysis hours.
Monitor your fluid intake between dialysis sessions as needing too much fluid taken off during dialysis can make you feel tired and washed out.
Rest after haemodialysis. Rest for an hour or two after each session until you feel less tired – this is sometimes referred to as ‘dialysis recovery time’ – but try not to fall asleep.
Talk to your healthcare team about possible treatments for itching if this is causing you difficulty.
If you are feeling anxious or depressed, talk to your healthcare team about the treatments and support available.
Ask your healthcare team if there is a local exercise programme for kidney patients. Gentle activity can be relaxing and may help to improve your sleep.
Plan your week so that activities are spread out rather than trying to do too much in one day.
Have plenty of rest periods throughout the day but try not to fall asleep.

Try to improve the quality of your sleep:

Try not to sleep during the day. However, if you find that a short nap helps, limit it to half an hour.
Avoid drinks containing caffeine late in the day.
Go to bed at the same time every night and wake up at the same time each morning.
Relax before bedtime.
Keep your bedroom dark, quiet and cool.
Avoid watching TV and using electronic devices an hour before bed.