Understanding Fatigue with Kidney Disease

While the gift of a kidney transplant has had such a positive impact on my life, I struggle with chronic fatigue. Soon after I was diagnosed with CKD, it was discovered I had sleep apnea. I underwent a sleep study, and the pulmonologist was shocked by the findings. I was a young man with a slender build, and the pulmonologist said that I did not look like the average person with sleep apnea, so he was surprised to find my sleep apnea was so severe. A Bilevel positive airway pressure (BiPAP) was prescribed with a high setting 20/25 and it worked well, and soon I was back to my normal self.

After my kidneys failed, I had sleep issues and fatigue, as many dialysis patients do. I suffered with washout after treatments and had to learn how to mitigate these issues by changing my diet, reducing fluid intake, and exercising. It didn’t always go well, but I managed.

After my kidney transplant, I felt amazing. My energy level was back, and I had all the benefits and freedom a kidney transplant offers. After a few years though, I began to feel fatigued at various times of the day. It hit me hardest in the late afternoon, but once again I managed. Over the years, however, it worsened and has impacted my ability to be productive and fully enjoy some of the things I like to do.

When the fatigue started to become more noticeable, I had a sleep study scheduled, assuming something had changed. My results were fine and showed the BiPAP was working well for me. We also checked my oxygen level; I had used oxygen at night previously, which had helped. My oxygen level was in the high range, and the doctors found I wasn’t in need of a concentrator during sleep. My nephrologist and cardiologist reviewed my lab results and medications and found nothing that stood out.

I have tried taking short naps that last 15–30 minutes, which I have not found to be helpful. Longer naps, in the 2–3 hours range, have been more helpful, but they affect the amount of time during the day I have to live my life. I can have a sound night’s sleep and still find myself needing to lay down within 4–5 hours after I wake. If I try to push through the day, I often feel ill, even nauseous at times, with the only relief being a long nap. The fatigue affects me more negatively than any other medical issues I currently have. During the day, I feel wiped out. I use caffeine, both coffee and tea, but still struggle.

The article published in this issue of CJASN, “Airflow Limitation, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients,” states that “Many kidney transplant recipients suffer from fatigue and poor health-related quality of life [HRQoL]. Airflow limitation may be an underappreciated comorbidity among kidney transplant recipients” (1). This may be the key to understanding my condition. The article explains that “The health status and reported HRQoL of kidney transplant recipients after successful transplantation depend largely on individual patient characteristics and comorbidities, rather than graft function alone. Consequently, underlying comorbidities are increasingly recognized as key targets to reduce fatigue and increase HRQoL among kidney transplant recipients. We propose that airflow limitation is an important, hitherto overlooked, comorbidity after kidney transplantation” (1). As a type 1 diabetic, having heart disease and vascular issues makes me a prime candidate for airflow limitation.

I remain hopeful after reading in the discussion section of the paper that “FEV₁ can be improved by high-intensity aerobic exercise training and the use of bronchodilator medication” (1). I will bring this to the attention of my care team to see if we can reduce my fatigue and therefore improve my quality of life.

Disclosures

D. Forfang serves as the co-chair of the Kidney Patient Advisory Council for The National Forum of ESRD Networks. He also serves as the Chair of the NKF Public Policy Committee and their Kidney Advocate Committee.

Funding

None.