What causes fatigue in patients undergoing hemodialysis (HD) for impaired renal function?

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Last updated: March 28, 2025 • View editorial policy

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From the Guidelines

Hemodialysis causes fatigue primarily due to the physically demanding process, inflammation, anemia, and sleep disturbances, which can be managed with proper nutrition, gentle exercise, adequate rest, and sometimes medications like erythropoiesis-stimulating agents. According to the most recent study by 1, fatigue is the most common symptom experienced by individuals undergoing hemodialysis, affecting at least half of the patients. The study highlights that the symptom burden extends beyond the patient to their caregivers and family members, emphasizing the need for comprehensive management.

Causes of Fatigue

The causes of fatigue in hemodialysis patients are multifactorial, including:

  • Rapid fluid and electrolyte shifts during dialysis, disrupting normal physiological balance
  • Intradialytic hypotension, reducing blood flow to muscles and the brain
  • Inflammation triggered by hemodialysis, consuming energy
  • Anemia due to decreased production of erythropoietin, reducing oxygen delivery to tissues
  • Strict dietary restrictions, medication regimens, and time commitment of dialysis sessions, contributing to physical and mental exhaustion
  • Sleep disturbances due to uremic toxins, restless leg syndrome, and sleep apnea

Management of Fatigue

Managing fatigue in hemodialysis patients requires a combination of:

  • Proper nutrition, as emphasized by 1, which highlights the importance of maintaining an adequate nutrient intake to prevent protein-energy malnutrition
  • Gentle exercise, when possible, as suggested by 1, which indicates that physical activity can reduce fatigue in patients with chronic kidney disease
  • Adequate rest, to mitigate the effects of sleep disturbances
  • Sometimes medications like erythropoiesis-stimulating agents, to treat anemia and improve oxygen delivery to tissues

Importance of Symptom Assessment

The study by 1 emphasizes the importance of incorporating symptom assessment into the patient's medical records, facilitating integration into the overall clinical assessment, and making the assessment accessible to both the multidisciplinary team and the patient. This highlights the need for a comprehensive approach to managing fatigue and other symptoms in hemodialysis patients.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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