Did you know?

Fatigue can either be Mental or Physical or a combination of both which is called General fatigue.

  • Mental fatigue is a symptom that affects your cognitive activity leaving you with a sensation of fogginess, exhaustion, and sleepiness.
  • Physical fatigue affects your body and leaves you feeling too tired to perform activities and feeling worn out.
  • General fatigue is the combination of both mental and physical fatigue is a very common condition in kidney transplant recipients.

If you received dialysis before transplantation, your body and your ability to be active as you were accustomed to may have changed over time. It’s ok to feel tired especially when you’ve had a difficult night or have done physical activity (e.g. going to the gym or walking up the stairs). From time to time most people feel fatigued for no particular reason!

  • Fatigue is very common in kidney transplant recipients affecting 40-50%. However, only 20% have their fatigue symptoms documented in their medical records.
  • Fatigue is associated with obesity, depression, sleep disturbances (e.g., inability to get adequate sleep), and anxiety/fear. It is important that transplant recipients be assessed immediately after transplantation.
  • Fatigue is very common among recipients who don’t take their immunosuppressive drugs as recommended by their doctors.
  • Physical activity has been proven to be effective in reducing fatigue in many patient populations.

How am I doing?

It is important that you track your level of fatigue every day. Use the scale below to rate your level of fatigue at the same time of the day.

If your fatigue levels are above 6 most of the time for no particular reason, you need to consult your healthcare provider. Take your notes about your daily fatigue scores with you so your healthcare provider can better assess your condition.

What can I do?

  • Ask your doctor if your blood profile levels are within normal limits, especially your hematocrit and ferritin levels.
  • Ask your doctor to check your Vitamin D levels – Vitamin D is crucial for both healthy bones and muscles and can affect your strength.
  • Discuss with your healthcare team about your immunosuppressive medication load. These medications can be toxic for your kidneys (nephrotoxic) and can also cause fatigue.
  • Track the number of hours you are sleeping and how rested you feel. Consider using a smart phone or smart watch if accessible. Sleep needs to be enough in both duration and depth.
  • Stay active. Physical activity is any bodily movement produced by the skeletal muscles that uses energy. This includes sports, exercise and other activities such as playing, walking, doing household chores or gardening. If you feel fatigued during physical activity, slow down a bit. Try a slower speed or lower intensity. Slow progress is better than no progress.
  • Remember: it is part of transplantation self-management process to learn to identify and manage fatigue. Plan your activities to increase your tolerance for physical effort.

How can I do it?

  • Don’t forget to track your level of fatigue using the scale provided above. If the level of fatigue is elevated (above 6), talk to your healthcare provider about your level of fatigue and share with them the information from your fatigue diary. Let them know how fatigue is impacting your overall quality of life and health. That way any medical issues affected by your fatigue sensations can be addressed.
  • Improve your sleep quality by controlling your bedroom light, sound, temperature, and humidity levels. A change of mattress or pillow should be considered.
  • Start measuring your daily activity (steps) every day by using a pedometer or a smart watch. Aim for more than 5000 steps per day if this is appropriate for your current condition.
  • Avoid continuous sitting for more than 20 minutes during the day. Interrupt sitting time by doing toe stands or sit to stand movements (5-10 repetitions)
  • Use the guidelines from the Canadian Society for Exercise Physiology (CSEP) for recommendations on physical activity and how to adhere to a healthy active lifestyle. (https://csepguidelines.ca)

More Information

This section was written by Dr. Georgios K. Sakkas, PhD, (Associate Professor in Clinical Exercise Physiology Live Laboratory, University of Thessaly; School of PE, Sport Sciences & Dietetics, Volos/Greece) and reviewed by Colin White (National Projects Manager, Irish Kidney Association; member of the Board of the World Transplant Games Federation and the European Transplant & Dialysis Sports Federation); Kent Bressler (MA RN; Kidney transplant recipient); Manuel Escoto (Patient, Family, Donor Partnerships & Education Manager, Canadian Donation and Transplantation Research Program; Kidney transplant recipient); AND by our research team.

References

  1. Van Sandwijk MS, Al Arashi D, van de Hare FM, van der Torren JMR, Kersten MJ, Bijlsma JA, Ten Berge IJM, Bemelman FJ. Fatigue, anxiety, depression and quality of life in kidney transplantrecipients, haemodialysis patients, patients with a haematological malignancy and healthy controls. Nephrol Dial Transplant. 2019 May 1;34(5):833-838. doi: 10.1093/ndt/gfy103.
  2. Bossola M, Pepe G, Vulpio C. Fatigue in kidney transplant recipients. Clin Transplant. 2016 Nov;30(11):1387-1393. doi: 10.1111/ctr.12846. Epub 2016 Oct 7.
  3. Griva K, Davenport A, Newman SP. Health-related quality of life and long-term survival and graft failure in kidney transplantation: a 12-year follow-up study. Transplantation. 2013 Mar 15;95(5):740-9.