What Causes Fatigue In Chronic Kidney Disease

What You Need To Know

You have two kidneys, located near the middle of your back, just below the rib cage. Each is about the size of your fist. Tiny structures called nephrons are inside each kidney and they filter the blood. There are about a million of them.

The kidneys are responsible for removing wastes, toxins and extra water from the body balancing important salts and minerals in the blood and releasing hormones to help control blood pressure, manage anemia and help maintain strong bones. The waste and extra water removed by the kidneys become urine. The urine flows through tubes called ureters. It goes to your bladder, which stores the urine until you go to the bathroom.

When the kidneys are damaged, they can’t filter blood as they should. The result can be a build-up of wastes in your body, as well as other problems that can harm your health.

One in three American adults is at high risk for developing kidney disease today. Yet most arent able to identify the signs and symptoms. One in nine American adults has kidney disease and most dont know it.

At first, kidney disease is silent. Symptoms often dont appear until the kidneys are badly damaged. Many people don’t have any symptoms until their kidney disease is advanced. Blood and urine tests are the only way to know if you have kidney disease.

Association Of Fatigue With Outcomes

There were 126 composite events, including 37 dialysis initiations, 18 deaths, and 115 hospitalizations. The number of composite outcome events in participants with stages 2, 3, 4, and 5 CKD was 2 , 42 , 48 , and 34 , respectively. A higher proportion of participants who reported any versus no fatigue on the QIDS-SR16 experienced the composite outcome during the follow-up . Such a difference did not reach statistical significance when using the BDI-I scale to ascertain the presence of fatigue . Event-free mean survival time to death, ESRD, or first hospitalization was shorter for those that reported any fatigue on the QIDS-SR16 at 242.6 days than in those that reported no fatigue at 291.0 days, log-rank p value = 0.01 .

Participants who reported any fatigue compared to those who reported no fatigue on the QIDS-SR16 were at an increased hazard of the composite outcome, hazard ratio 1.70 . This association remained significant even after controlling for demographic variables , number of medical comorbidities and current or past drug use, laboratory data , and beta blocker use, HR 1.62 . However, the association became nonsignificant after adjusting for antidepressant use or MDD. No significant association was observed between the composite outcome and fatigue reported on the BDI-I, even in the unadjusted model, HR 1.49 .

Table 3.

Association of self-reported fatigue with primary outcome

Managing Chronic Kidney Disease

The Center for Disease Control and Prevention refers to Chronic kidney disease as a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke.CKD is characterized by a gradual decline in kidney function. This condition has varying levels of seriousness. It usually gets worse over time, though treatment has been shown to slow progression. If left untreated, CKD can progress to kidney failure and early cardiovascular disease. When the kidneys stop working, dialysis or kidney transplant is needed for survival. Kidney failure treated with dialysis or kidney transplant is called end-stage renal disease . .

The Kwali4u team cares about your health and well-being. In this blog we will share with you some useful information and tips on what causes chronic kidney disease, its symptoms, and recommended lifestyle changes.

Causes of chronic kidney disease include diabetes, high blood pressure, glomerulonephritis , and polycystic kidney disease which refers to an inherited disorder in which clusters of cysts develop primarily within the kidneys, causing the kidneys to enlarge and lose function over time. Risk factors include a family history of CKD, heart disease, obesity, inherited kidney disorders, past damage to the kidneys, and advanced age.

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Inorganic Nitrates And Nitrites

Inorganic nitrate and nitrite supplementation are emerging as a promising strategy to improve exercise intolerance in aging and disease populations. Acute administration of inorganic dietary nitrate in the form of concentrated beetroot juice has been shown to improve the ventilatory threshold, total CPET exercise time, and the total amount of work performed during a CPET in patients with stage 3â4 CKD . The proposed mechanisms of inorganic nitrate induced improvements in exercise capacity are through improving vascular function and therefore increasing oxygen delivery to the skeletal muscle . In addition, inorganic dietary nitrate supplementation has been shown to improve arterial hemodynamics, thereby reducing the left ventricular pulsatile load during exercise . The findings are promising for current trials investigating chronic supplementation .

With advancements in our knowledge of the physiological contributors to CKD-related exercise intolerance, there is currently a large body of clinical trials underway that are investigating pharma and nutraceutical approaches to address this important problem . Future treatments that target the causes of the pathophysiology such as uremia, metabolic acidosis, inflammation, and oxidative stress may be effective strategies for a âwhole-systemsâ approach to improving exercise capacity.

What Can I Do To Manage My Exhaustion

• If you are prescribed medications to treat anaemia, make sure you take them as instructed.
• If you are receiving dialysis, make sure you complete your prescribed dialysis hours.
• Watch 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. When you get home, rest for an hour or two 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 depressed or anxious, ask your healthcare team if you can be referred to a counsellor or psychologist who may help you to manage these feelings.
• Ask your healthcare team if there is a local exercise programme for kidney patients. A gentle exercise programme 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:

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Correction Of Phosphate Balance

If you have stage four or five kidney disease, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it. Phosphate is a mineral that, with calcium, makes up most of your bones. Phosphate is obtained through diet, mainly dairy foods. The kidneys usually filter out excess phosphate. If phosphate levels rise too much, it can upset the normal calcium balance of the body. This can lead to thinning of the bones and furring of the arteries.

You may be asked to limit the amount of phosphate in your diet. Foods high in phosphate include red meat, dairy produce, eggs and fish. Your GP or dietitian should be able to advise you about how much phosphate you can eat. However, there is no advantage in reducing your intake of these foods unless you have a raised phosphate level. Always ask a healthcare professional before changing your diet.

If reducing the amount of phosphate in your diet does not lower your phosphate level enough, you may be given medicines called phosphate binders. These medicines bind to the phosphate in the food inside your stomach and stop it from being absorbed into your body.

To work properly, phosphate binders must be taken just before meals. The most commonly used phosphate binder is calcium carbonate, but there are also alternatives that may be more suitable for you.

The side effects of phosphate binders are uncommon but include:

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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Medication To Reduce Cholesterol

Studies have shown that people with CKD have a higher risk of cardiovascular disease, including heart attacks and strokes. This is because some of the risk factors for CKD are the same as those for heart attacks and strokes, including high blood pressure and high levels of cholesterol in the blood .

Statins are a type of medication used to lower cholesterol levels. Cholesterol causes narrowing of the arteries that can lead to a blockage of the blood supply to the heart or the brain . Statins work by blocking the effects of an enzyme in your liver , which is used to make cholesterol.

Statins sometimes have mild side effects, including:

Occasionally, statins can cause muscle pain, weakness and tenderness. If you experience any of these symptoms, contact your GP. You may need to have a blood test or change your treatment.

If you have kidney disease, you may be asked to reduce your daily fluid and salt intake. You may develop a build-up of fluid as your kidneys will not be able to get rid of fluid as well as they did before.

If you are asked to reduce the amount of fluid you drink, you must also take into account fluid in foods, such as soup and yoghurt. Your GP or dietitian can advise you about this.

The excess fluid that occurs as a result of kidney disease often builds up in your ankles or around your lungs. You may also be given diuretics , such as furosemide, which will help get rid of the excess fluid from your body.

What Did This Study Do

This systematic review and thematic synthesis describes patient perspectives on the meaning and impact of fatigue while undergoing haemodialysis. Sixty-five qualitative studies are included in the review representing the views of 1,713 patients undergoing haemodialysis.

Patients were based in 15 countries, including the UK but predominantly based in the United States, Australia, Sweden and Canada. Nine studies explicitly included fatigue in the aim of their study 56 studies included perspectives of fatigue within the broader scope of their study.

The quality of reporting was independently assessed using the Consolidated Criteria for Reporting Qualitative Health Research framework. Only English-language articles were included in the review with most studies undertaken in high-income countries.

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What We Can Learn From Chronic Fatigue

A disorder called CFS is generally defined by persistent mental and physical fatigue accompanied by other specific symptoms . While its causes are undefined, it is managed as a syndrome and sufferers are offered multidisciplinary care.

Patients on maintenance HD therapy share many similarities to those suffering by CFS since they experience generalized weakness , exercise in tolerance , and disturbed sleep all leading to a sense of generalized fatigue and lack of energy . This chronic state of HD Fatigue among HD patients satisfies one major requirement for the diagnosis of CFS which is persistent fatigue present at least during 50% of the time over a period of at least 6 months . However, as renal failure is present, the second requirement for the diagnosis of CFS, which is the absence of disease, is contradicted. So far the single symptom approach of fatigue in HD patients did not succeed to ameliorate patients sense of fatigue and therefore, by viewing signs and symptoms of fatigue in a holistic approach would at least allow practitioners and scientists to address the problem as efficiently as in CFS patients. Such an approach will be challenging, given the variety in intensity and the causes of these symptoms, but not impossible, and can hold large benefits to the patients quality of life as the CFS treatments have shown so far in other populations.

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.

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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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Perspective And Research Directions

We believe that the current descriptions of HD fatigue point to a syndrome. In current practice, treatment for fatigue symptoms and signs, if offered, and dependent on the country and type of care facility, is given mostly by the nephrologists and sometimes by the nursing staff. We believe that to address such complex symptomatology necessitates a more holistic approach which should include other specializations such as neurologists, psychiatrists, exercise physiologists, pain management specialists, and others. It is difficult to effectively treat symptoms such as lack of energy and signs such as muscle weakness as it is obvious that they cannot be treated fragmentarily, e.g., only with pain killers or antidepressants. A multidisciplinary approach is needed and we propose that while challenging, to formulate, it will be rewarding for patients, health care providers, and scientists.

Future research needs to focus on clinical and functional examination of those HD patients with severe and persistent fatigue vs. those with no or minimal signs and symptoms and clarifying whether or not HD Fatigue may be equivalent to CFS. This could lead to better care for HD patients.

Who Created Who Came Up With The Kidney Disease Solution Program

The Kidney Disease Solution was created by Duncan Capicchiano and his wife, Fiona Chin, from Melbourne, Australia. They established a wellness center in Melbourne with more than 13 health professionals who are natural.

As fully qualified Naturopaths and Naturopaths, they have a common background in herbal and natural therapy.

The program was initially designed as an alternative treatment option for Fionas grandmother, diagnosed with stage 4 renal disease. The couple devised an all-natural program which helped improve her condition in just 12 weeks. After six months of treatment, she improved from stage 4 to stage 1, and she lived healthily for the remainder of 10 years.

Due to their successes with Fionas mother, they decided to launch and share their treatment approach to those suffering from kidney disease.

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Clinical Management Of Fatigue

Fatigue in this patient population is unique due to the multidimensional nature of dialysis, and in turn, is difficult to manage. Effective treatment of fatigue is further complicated in this patient population because we do not understand the cause of fatigue. Currently, there is nominal research examining genetic associations with fatigue. Some research has examined potential medical treatment options for fatigue, such as the correction of anemia and physical activity to improve clinical outcomes with varying success . Many of the research studies examining interventions to prevent or mitigate fatigue in individuals with ESRD are limited by small sample sizes and a lack of randomization . Interventions to prevent and mitigate fatigue include pharmacological and non-pharmacological strategies . Pharmacological interventions to mitigate fatigue include vitamin C and L-carnitine . Nonpharmacological interventions to mitigate fatigue include exercise, acupressure, trans cutaneous electrical acupoint simulation , psychological interventions, and correction of anemia . Table 4 depicts the most recent and sentinel studies addressing pharmacological and non-pharmacological interventions for fatigue in individuals with ESRD.

How Does This Kidney Disease Solution Program Work

The cookbook, ebook, and audio material guide people through the process step-by-step. The ebook contains guidelines on changing your lifestyle to improve kidney health. In addition, the cookbook provides special recipes to support kidney function and health. Additionally, it offers several natural remedies that could help treat your condition.

The audio material provides guided meditation and exercises and Morning yoga flows. The guided meditation audio is effective in relieving stress and improving the quality of sleep. Yoga flow exercises in the morning taught by the renowned yoga teacher Antonella Milo, are designed to boost your energy for the day while supporting kidney health.

The overall collection of products offers a comprehensive and natural way to treat kidney disease. Through simple lifestyle changes and releasing stress through meditation and yoga exercises, you will be able to say goodbye to the pain and discomfort that are caused by the kidney condition.

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