How To Combat Fatigue From Kidney Disease

What To Expect If Youre Facing Kidney Failure

Your outlook depends on the type of kidney failure.

If you have chronic kidney failure, your kidneys cant recover, but you can slow its progression with the right treatment, unless you receive a kidney transplant.

If you have acute kidney failure, your kidneys will most likely recover and start to work again.

Limitations And Future Directions

Although there is promising evidence with regards to the role of psychological factors in the experience of fatigue in this setting, it is important to emphasize that most of the evidence originates from cross-sectional studies and therefore, no conclusive interpretations in relation to causality can be drawn. Considerably less research is available on psychological factors in fatigue among transplant recipients and patients in pre-dialysis care. Corroboration of the evidence for the role of social support, self-efficacy and illness intrusiveness in fatigue is necessary. Also, longitudinal studies are warranted to provide causal evidence, particularly for the associations between depression, anxiety, subjective sleep quality and fatigue. Given the evidence for differences in illness beliefs depending on RRT, it would be valuable for future research to compare fatigue-specific beliefs according to what RRT patients are receiving.

Data Collection And Intervention

After getting to know the patients undergoing hemodialysis the day before the study, a nephrologist examined the patients to make sure there was no medical restriction for entering the study. Afterwards, the MFI was completed by the intervention and control groups. Then, the exercise program was conducted twice a week for 12weeks simultaneously with the hemodialysis sessions. Patients exercised for 20min during the first 2 h of the hemodialysis using the electric exercise bike .

The two groups filled the MFI at the end of each month during the intervention and 1 month after the intervention. Given the assumption that continuous, long-term exercise can affect the level of fatigue, the study attempted to measure the effect of long-term exercise on fatigue as well as the level of fatigue at different times . The study lasted from 15 October 2018 to 22 April 2019.

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Inflammation And Oxidative Stress

Inflammation and oxidative stress have both been identified as being involved in both the development and progression of CKD . Low magnesium is associated with an increase in oxidative stress and increased production of inflammatory molecules.

Magnesium has been shown to fight inflammation, lowering inflammatory markers in the body. Magnesium is also a cofactor of several antioxidant enzymes in the body, for example, glutathione, one of the bodys primary antioxidants, needs magnesium for its production.

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How Is Kidney Failure Diagnosed

Doctors use a variety of tests to measure kidney function and diagnose kidney failure. If your doctors suspect you may be at risk for kidney failure, they may recommend:

• Blood tests, which can show how well the kidneys are removing waste from the blood.
• Advanced imaging, which can show kidney abnormalities or obstructions .
• Urine tests, which measure the amount of urine or specific substances in the urine, such as protein or blood.

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What Did It Find

• Patients experience debilitating and relentless exhaustion because of haemodialysis-related fatigue, which encompasses their whole body and can persist beyond the immediate treatment period.
• Haemodialysis-related fatigue restricts patients ability to engage in usual activities, because of the time needed to get to clinics and complete treatment about three times a week, needing to rest between treatments, and managing energy reserves.
• Patients ability to fulfil relationship roles is hampered by haemodialysis-related fatigue. For example, impacts are felt on parenting, lack of stamina for sexual intimacy, or reduced ability to work and provide for their family.
• Haemodialysis-related fatigue can leave patients feeling vulnerable to criticisms of laziness when they need to rest.
• Patients feel that haemodialysis-related fatigue can lead to misunderstanding when they fail to meet the expectations of friends and family.

Things You Should Understand About Living With Kidney Disease

A simple question “What do you wish others understood about living with kidney disease?” unleashed a torrent of comments on our Facebook page recently. Kidney disease itself is often invisible until the late stages once it progresses to kidney failure, you will need dialysis or a transplant to live. People living with kidney disease and kidney failure tell us they often feel that others do not understand what they are going through, both physically and emotionally.

Several common themes emerged on our Facebook page. Here are the four things people living with kidney disease most wish others would understand.

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Why Was This Study Needed

At any one time, there are approximately 5,000 patients in the UK waiting for a kidney transplant following established renal failure. Less than 3,000 kidney transplants are carried out each year with most patients also requiring dialysis to prolong life while awaiting transplantation.

Haemodialysis removes waste products which build up in the blood when the kidneys no longer function properly. Treatment is usually undertaken three times a week for approximately three to four hours. The UK Renal Registry reports that as of December 2016, the median time a patient spends on haemodialysis is 3.2 years.

Fatigue affects 60% to 97% of patients undergoing haemodialysis. Patients consistently rate haemodialysis-related fatigue as an important patient-defined health outcome above survival, mobility and pain.

This review of English language articles promotes a fuller understanding of patient perspectives of haemodialysis-related fatigue.

Study Design Setting And Participants

This is a prospective cohort study of consecutively recruited outpatients with CKD-ND. Institutional Review Board approval was obtained in accordance with the ethical standards. CKD-ND patients were approached consecutively during routine clinic visits at the Dallas Veterans Affairs Medical Center. Prior to enrollment, written informed consent was obtained. Inclusion criteria were stages 25 CKD-ND and the ability to participate in informed consent. CKD-ND was defined as either estimated glomerular filtration rate < 60 mL/min/1.73 m2 or eGFR 6089 with another marker of kidney disease, such as albuminuria, proteinuria, hematuria, or abnormal pathology on kidney imaging or biopsy, present for at least 3 months prior to enrollment. Stage 2 CKD-ND was defined eGFR 6089 with another marker of kidney disease stage 3, eGFR 3059 stage 4, eGFR 1529 and stage 5, eGFR < 15 . Patients on chronic peritoneal dialysis or hemodialysis and kidney transplant recipients were excluded.

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Signs You May Have Kidney Disease

More than 37 million American adults are living with kidney disease and most dont know it. There are a number of physical signs of kidney disease, but sometimes people attribute them to other conditions. Also, those with kidney disease tend not to experience symptoms until the very late stages, when the kidneys are failing or when there are large amounts of protein in the urine. This is one of the reasons why only 10% of people with chronic kidney disease know that they have it, says Dr. Joseph Vassalotti, Chief Medical Officer at the National Kidney Foundation.

While the only way to know for sure if you have kidney disease is to get tested, Dr. Vassalotti shares 10 possible signs you may have kidney disease. If youre at risk for kidney disease due to high blood pressure, diabetes, a family history of kidney failure or if youre older than age 60, its important to get tested annually for kidney disease. Be sure to mention any symptoms youre experiencing to your healthcare practitioner.

Recommendations For All Stages Of Ckd

The goals of a CKD diet are to slow the progression of the disease and minimize any harm the accumulation of waste and fluids can do to other organs, most predominately the heart and cardiovascular system.

To this end, you would need to immediately adjust your diet in three key ways:

• Reduce your sodium intake. According to the current guidelines, you should consume no more than 2,300 milligrams of sodium per day for adults and no more than 1,000 to 2,200 mg for children and teens. If you are African American, have high blood pressure, or are over 50, you would need to further restrict your intake to 1,500 mg daily.
• Limit the intake of protein. The amount can vary based on the stage of disease. The current recommendation for people with stage 1 to stage 4 CKD is 0.6 to 0.75 grams of protein per kilogram of body weight per day, which broadly translates to:

• Choose heart-healthy foods. The number one cause of death in people with ESRD is cardiac arrest. To this end, many kidney specialists will endorse the use of a DASH diet which focuses on portion control, getting the right amount of daily nutrients, and eating a variety of heart-healthy foods.

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Benefits Of A Kidney Disease Diet

According to the National Kidney Foundation, 37 million American adults have chronic kidney disease. People with CKD often need to change what they eat to help avoid further damage to their kidneys.

Following a renal disease diet can help preserve kidney function and prevent further decline in their ability to filter the blood of waste and fluids. This can help decrease some symptoms of kidney disease, such as fatigue, loss of appetite, problems with urination, and kidney pain.

In addition, following a healthy renal diet can help provide you with energy, maintain a healthy weight, decrease infections, and prevent loss of muscle mass. Continue reading to learn more about diet for people with kidney disease.

Biochemistry And Hematology Factors

Int Urol Nephrol.Clin Nephrol.Clin J Am Soc Nephrol.Ren Fail.Nephrol Nurs J.

• Schneider M.F.

Am J Kidney Dis.J Clin Nurs.Res Nurs Health.Clin J Am Soc Nephrol.J Adv Nurs.ANNA J.

• Cantekin I.

Scand J Urol Nephrol.Nurs Health Sci.Am J Nephrol.Nurs Health Sci.Nephrol Dial Transplant.

et al.Kidney Int Suppl.J Clin Nurs.Qual Life Res.

Int J Psychiat Med.Clin J Am Soc Nephrol.Blood Purification.Ren Fail.Clin Nephrol.Int J Nurs Pract.Clin J Am Soc Nephrol.Am J Kidney Dis.Res Nurs Health.Res Nurs Health.J Clin Nurs.J Adv Nurs.Am J Nephrol.Clin Nephrol.Am J Nephrol.Am J Kidney Dis.Res Nurs Health.Blood Purification.Clin J Am Soc Nephrol.J Clin Nurs.J Adv Nurs.

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Modifying Behavioural Components To Fatigue

Significant central fatigue warrants lifestyle changes, which may include rest periods and reduced workloads . However, the maintenance of physical activity is of paramount importance. The natural inclination of patients with central fatigue is to decrease physical activity. However, decreased physical activity over time will lead to cardiovascular and muscular deconditioning, which then makes physical activity even more difficult . Therefore, all patients need to be counselled with regard to maintaining an appropriate level of activity. In addition, an increase in activity should be attempted through the institution of a graded exercise program .

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Findings From The Thematic Analysis

Six main themes emerged through the thematic analysis and are discussed in more detail below. Figure is a thematic diagram of the identified themes and subthemes.

Figure 2

This theme encompassed participants causal beliefs around fatigue, with biomedical explanations of fatigue prevailing.

1.1 Biomedical explanations of fatigue

there is a fatigue that I do associate with dialysis, and that is when the machine goes on suddenly, Im exhausted.

On the other hand, almost all participants expected their energy levels to improve with a kidney transplant. The role of anaemia and biochemical factors in the initiation of fatigue also emerged: I think the fatigue is in fact all about the iron .

1.2 Other aetiologies of fatigue

2. Double-Edged Fatigue

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Can Kidney Failure Be Prevented

While kidney failure from chronic kidney disease cant be reversed, you can do many things to help preserve the kidney function you have today. Healthy habits and routines may slow down how quickly kidneys lose their functional abilities.

If you have chronic kidney disease or kidney failure, youll want to:

• Monitor your kidney function, with your doctors help.
• Keep your blood sugar levels under control, if you have diabetes.
• Keep your blood pressure levels in a normal range.
• Avoid smoking.
• Make healthy diet choices, such as limiting foods high in protein and sodium.

Medications For High Blood Pressure

One of the main ways to reduce the progression of kidney damage is to manage high blood pressure. Good control of blood pressure is vital to protect the kidneys.

People with CKD should aim to get their blood pressure down to below 140/90mmHg but if you also have diabetes you should aim to get it down to below 130/80mmHg.

There are many types of blood pressure drugs. Medicines called angiotensin converting enzyme inhibitors are used to control high blood pressure in people with CKD.

As well as reducing blood pressure around the body and reducing the strain on blood vessels, ACE inhibitors give additional protection to the kidney.

ACE inhibitors include:

Side effects of ACE inhibitors include:

• a persistent, dry cough
• tiredness or weakness

Most of these side effects should pass within a few days, although some people continue to have a dry cough.

If the side effects of ACE inhibitors are particularly troublesome, you can be given an alternative medication called an angiotensin-II receptor blocker . This group of medicines includes:

• candesartan

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Feeling Faint Dizzy Or Weak

Why this happens:

Anemia related to kidney failure means that your brain is not getting enough oxygen. This can lead to feeling faint, dizzy, or weak.

What patients said:

I was always tired and dizzy.

It got to the point, like, I used to be at work, and all of the sudden I’d start getting dizzy. So I was thinking maybe it was my blood pressure or else diabetes was going bad. That’s what was on my mind.

Upset Stomach Nausea Vomiting

Why this happens:

A severe build-up of wastes in the blood can also cause nausea and vomiting. Loss of appetite can lead to weight loss.

What patients said:

I had a lot of itching, and I was nauseated, throwing up all the time. I couldn’t keep anything down in my stomach.

When I got the nausea, I couldn’t eat and I had a hard time taking my blood pressure pills.

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Prognosis Of Chronic Kidney Disease

If chronic kidney disease is caused by a disorder that can be corrected and if that disorder has not been present for too long, then kidney function may improve when the causative disorder is successfully treated. Otherwise, kidney function tends to worsen over time. The rate of decline in kidney function depends somewhat on the underlying disorder causing chronic kidney disease and on how well the disorder is controlled. For example, diabetes and high blood pressure, particularly if poorly controlled, cause kidney function to decline more rapidly. Chronic kidney disease is fatal if not treated.

When the decline in kidney function is severe , survival is usually limited to several months in people who are not treated, but people who are treated with dialysis Dialysis Dialysis is an artificial process for removing waste products and excess fluids from the body, a process that is needed when the kidneys are not functioning properly. There are a number of reasons… read more can live much longer. However, even with dialysis, people with end-stage kidney failure die sooner than people their age who do not have end-stage kidney disease. Most die from heart or blood vessel disorders or infections.

Factors Associated With Fatigue In Chronic Kidney Disease Patients Undergoing Hemodialysis: A Systematic Review

Vol 31, No 4 , pp.260-268

Abstract

Fatigue is the primary complaint most frequently reported by patients on hemodialysis. The importance of knowing the factors related to fatigue is a strategy that can be carried out by health workers in optimally applying interventions to reduce patient fatigue problems. This systematic review aimed to determine the factors associated with fatigue in patients undergoing hemodialysis. The systematic review method began by identifying research articles in the Pubmed, ProQuest, Ebsco, and ScienceDirect databases in 20112020. Review protocol was using PRISMA. Based on the results of the analysis, it was obtained 23 articles that discussed demographic factors, physiological factors, socioeconomic factors, situational factors, and psychological factors that could be associated with fatigue in hemodialysis patients. There is much to learn about fatigue in patients undergoing hemodialysis, including causative factors, assessment of severity, and effective management of fatigue so that it can be used as a benchmark for determining appropriate interventions.

Keywords

Full Text:

References

Kidney Disease Improving Global Outcomes . Global Burden of Dialysis Initiation . Madrid: Controversies Conference on Dialysis Initiation, Modality Choice & Prescription. 2018. https://kdigo.org/wp-content/uploads/2017/02/Jha_KDIGO-Dialysis-Jan-2018.pdf.

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Kidney Health Grocery List

This is another excellent supplement to your cookbook as well as a meal plan. The main ingredient to have an ideal kidney health is diet, which is why you must to switch out unhealthy foods with nutritious ones. This useful guide helps you select the most nutritious food items the next time you are shopping for groceries. It lists out what foods to eat and what to avoid to boost kidney function.

Discuss Your Food Choices With Your Healthcare Provider

If you have kidney disease, your healthcare provider will want to regularly check your blood to ensure certain nutrients are within a safe range. This might include sodium, potassium, phosphorus, calcium, vitamin D, and albumin. Based on your blood test results, your doctor or dietitian may recommend you limit or avoid certain foods.

To achieve and maintain healthy blood levels of these substances, its important to discuss your food choices with your healthcare team to ensure the best specific kidney-friendly diet, as the foods you eat can impact your kidney function.

A registered dietitian can help educate you on foods to limit and help you find food and beverages that are safe for you to eat.

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