Kidney School™—a program of Medical Education Institute, Inc.

Module 12—Staying Active with Kidney Disease

Fatigue and Anemia

People with kidney disease often have anemia—a shortage of oxygen-carrying red blood cells. Why? Because they do not have healthy kidneys that make a hormone called erythropoietin, or EPO, that tells the bone marrow to make red blood cells. As the kidneys fail, they make less EPO, so you have fewer red blood cells—and less oxygen. When this happens, you may feel:

  • Short of breath
  • Cold all the time
  • Tired, tired, tired (fatigue!)

There are many types of anemia, though the most common ones related to CKD are based on a lack of erythropoietin and iron. If you think anemia may be a reason why you feel tired, read Module 6—Anemia and Kidney Disease. Module 6 will help you learn more about symptoms, tests, and treatments to help you feel your best.

Fatigue and Depression

Sometimes people with CKD lack energy because they are depressed. Depression is very common among people with all kinds of chronic diseases. Depression can make you feel as if you're walking through molasses—everything becomes much harder to do.

If you have more than one of the following symptoms for longer than 2 weeks, you may be depressed. Check off any symptoms that apply to you:

Persistent sad, anxious, or empty feelings
Loss of interest in usually pleasurable activities
Fatigue, loss of energy
Feeling worthless, helpless, or guilty
Significant weight loss—or gain
Insomnia—or sleeping more than usual
Restlessness and irritability
Trouble concentrating, remembering, or making decisions
Thoughts of death or suicide
Other symptoms I have that might be related to depression:

Some symptoms of depression, like fatigue, loss of energy, weight gain/loss, and sleeping problems, can also be caused by your kidney disease or its treatment. Talk to your health care team about your symptoms and your concerns. If you are depressed, know that depression can be treated—and treating it can help improve your energy level. For more information about depression, read Module 5—Coping with Kidney Disease.

What People with CKD Say About Fatigue

"Sometimes we don't realize just how tired we are because it is insidious, and we no longer remember what normal feels like.

"Because of the exhaustion, most things seem too hard. I cook and do dishes and do laundry and am very active in my church, trying to help others...but I have no stamina left for art or music or writing or the creative things I used to do that put spark in my life." –Nancy, 63 years old

"I don't think I had any idea just how tired I was until I started dialysis and started getting some strength back. In my case, kidney failure was slow, so I just didn't realize how much it was affecting me. TIRED doesn't even begin to describe it! And it's the one effect that still bothers me the most; I sure do miss my energy. But I learn to work around it and take advantage of the times when I am feeling good and to just rest and not fight it." –Robin, 47 years old

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