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Managing Fatigue With Chronic Kidney Disease

Reviewed by: HU Medical Review Board | Last reviewed: February 2023

Fatigue is the medical term for feeling very tired or weak for long periods of time. Fatigue is not the mild tiredness that healthy people feel at one time or another. Fatigue is physical and mental exhaustion that prevents you from doing daily activities.1

Fatigue is a common symptom of chronic kidney disease (CKD). In fact, studies show that 7 out of 10 people with kidney disease report fatigue, and 1 out of 4 feel severe tiredness. Fatigue generally is most common in the later stages of CKD, when a person's glomerular filtration rate (GFR) drops below 45. It is most severe during dialysis treatment.1,2

Fatigue is an important symptom to manage because it has a chicken and egg quality. Fatigue often results in avoiding exercise, self-care, and social activities. This leads to a poorer overall quality of life. But a poorer quality of life can lead to:1,2

  • More weakness
  • Worse kidney function
  • Having to start dialysis
  • More hospital stays

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Common signs of fatigue

Fatigue affects people with CKD in different ways, such as:3

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  • Feeling tired most of time
  • Lacking the energy to get up, bathe, and get dressed
  • Finding it hard to concentrate or remember things
  • Feeling sad, depressed, or anxious

If you notice any of these signs of fatigue, talk to your doctor. There are treatments and lifestyle changes you can try to help improve your energy levels.

Causes of fatigue in kidney disease

The fatigue felt by people with CKD may be caused by many things, including:1,2

  • Anemia
  • Lower oxygen levels in the blood
  • Changes in how the body uses energy
  • Muscle weakness and muscle loss
  • Depression
  • Problems sleeping
  • Malnutrition
  • Heart problems

Almost everyone with CKD experiences these symptoms. Treating and managing your CKD and its many symptoms can help lessen fatigue.1,2

Managing fatigue when you have CKD

More research about CKD-related fatigue is needed. But several treatments show some success in treating fatigue in different people.1


Getting more active is one of the best ways to improve physical and mental exhaustion. Movement improves blood oxygen levels and slows muscle loss, which improves energy and weakness. More activity during the day may also improve sleep quality. Small studies show that even a few minutes of activity per day can help with CKD fatigue.1,3

However, exercise can be challenging when you feel tired. Your kidney care team can recommend an exercise program designed for people with CKD. You also may want to plan activities to avoid doing too much at once. You can spread out chores and social events throughout the week.1,3

Make sure to build in rest time, but try not to sleep during the day. Sleeping during the day may make it harder to sleep at night.1,3


Your doctor may prescribe several drugs or devices to help manage your fatigue, including:1,3

  • Medicines for anemia (erythropoietin or iron supplements)
  • Antidepressants
  • Medicines for restless legs syndrome
  • Treatment for sleep apnea (CPAP machine)
  • Treatment for severe itching
  • Pain management

More dialysis

If your kidneys have already failed, you may need more dialysis. Too little dialysis can cause tiredness as toxins build up in your blood. You doctor will give you tests to find out whether more dialysis may help.3

Lifestyle changes

In addition to physical activity, other lifestyle changes may help improve how much fatigue you feel:3

  • Take medicines as prescribed.
  • Ask a kidney dietitian to review your diet and make sure you are getting enough nutrition.
  • Make sure you complete the amount of dialysis prescribed.
  • Control your fluid intake between dialysis sessions. Needing too much liquid removed during dialysis can make you more tired.
  • Rest for an hour or 2 after hemodialysis.
  • See a counselor if you feel depressed or anxious.

Finding ways to manage your fatigue may require trial and error. No single lifestyle change, diet, or medicine helps everyone. And many treatments that help with fatigue may interfere with other treatments for kidney disease. Talk to your healthcare team about what may work for you.1

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Which of the following conditions is related to chronic kidney disease?