Search
Search
Close this search box.

Here Comes That Old Refrain

Here Comes That Old Refrain

If this sounds familiar, it’s only because I’ve written about it several times in the last 13 years. I’ll bet you’ve already figured out today’s topic is fatigue. Let’s do my usual start-at-the-beginning routine. My very favorite dictionary since college [I can’t believe that was almost 50 years ago.], Merriam- Webster, offers a multitude of definitions.

We can skip the 1st and 3rd definitions as the first deals with the military and the third with materials, rather than humans. I’m referring to the noun [person, place, thing, or idea] definition rather than those for the verb or adjective. Furthermore, of the three definitions in the noun form, we’ll use only the second because the first deals with weariness and the third with apathy.

I know, I know, you want to know the definition already. Here it is:

“the temporary loss of power to respond that is induced in a sensory receptor (see RECEPTOR sense a)     or motor (see MOTOR entry 2 sense 1) end organ by continued stimulation.”

You know you’re right if you’re thinking I’ve never approached fatigue from this angle before. It’s new to me, too, so we’ll both be learning today. Ready for more definitions? This one is for sensory receptor:

“a cell or group of cells that receives stimuli”

And this is for motor end organ:

a

causing or imparting motion

b

of, relating to, or being a motor neuron or a nerve containing motor neurons

motor fiber

c

of, relating to, concerned with, or involving muscular movement

Let’s ignore ‘a’ for the time being and see what we can do with ‘b’ and ‘c.’

Whoa there, Gail! You never explained the connection between fatigue and chronic kidney disease. Better do that before we start exploring how it affects your CKD.

“Extreme, on-going tiredness, together with a lack of energy, is often called fatigue. If your kidneys are not working well, toxins (waste products) build up in your blood and this can make you feel tired and weak. You may feel more tired as your CKD progresses.

  • Kidney damage can also lead to a shortage of red blood cells, causing you to be anaemic. If anaemia is not treated, it can result in you feeling more tired than usual and lacking in energy.
  • If you are receiving haemodialysis you may find that you feel very tired after the treatment. People describe this as feeling ‘washed out’ or ‘drained’. This can last for a few hours after each session or much longer. This feeling may improve over time as your body gets used to the dialysis.
  • Poor sleep quality can also cause fatigue, particularly if you have problems falling or staying asleep or if you sleep during the day.
  • Itching is common in people with kidney disease and can also cause disturbed sleep.
  • A small number of people suffer from a condition called sleep apnoea, when your breathing stops and starts while you sleep.
  • Some kidney patients complain of restless legs syndrome. This is a feeling that your legs need to keep moving. It often occurs when lying in bed at night and can prevent people from sleeping well.
  • Feeling depressed or anxious can also cause sleeplessness and fatigue. For example, you may be having so many anxious or worrying thoughts that they keep you awake at night so you are tired during the day.”

Ready to explore the specific science behind fatigue now? I’m willing to give it a try. I turned to WebMD:

Kidney Care UK offers a comprehensive explanation:

“The messages traveling in your nerves are sent through billions of nerve cells called neurons. [Gail here: this includes motor neurons.] The spaces between these cells are called synapses. The cells are linked to one another through chemicals called neurotransmitters that move across the synapses to the next neuron. Dopamine and serotonin are types of neurotransmitters.

This process continues until the message gets to the right place. Some messages move faster than 200 miles per hour.

This is also how messages get from your body back to your brain and spinal cord.”

Hmm, it seems to me that everything we have so far is saying that when neurons between the brain and the kidneys go awry, we can end up with fatigue. Of course, that’s not the only way to become fatigued, but it does explain how your kidneys not working as well as they could allows toxins to build up in your bloodstream. Compromised blood circulates through your brain and you find yourself not just tired but fatigued.

<img data-attachment-id="6234" data-permalink="https://gailraegarwood.wordpress.com/2022/08/15/move-it-please/pexels-photo-903171/" data-orig-file="https://gailraegarwood.files.wordpress.com/2022/08/pexels-photo-903171.jpeg" data-orig-size="1880,1253" data-comments-opened="1" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}" data-image-title="women having exercise using dumbbells" data-image-description data-image-caption="

Photo by Andrea Piacquadio on Pexels.com

” data-medium-file=”https://gailraegarwood.files.wordpress.com/2022/08/pexels-photo-903171.jpeg?w=300″ data-large-file=”https://gailraegarwood.files.wordpress.com/2022/08/pexels-photo-903171.jpeg?w=470″ src=”https://renal.platohealth.ai/wp-content/uploads/2023/09/here-comes-that-old-refrain-2.jpg” alt class=”wp-image-6234″ width=”287″ height=”191″ srcset=”https://renal.platohealth.ai/wp-content/uploads/2023/09/here-comes-that-old-refrain-10.jpg 287w, https://renal.platohealth.ai/wp-content/uploads/2023/09/here-comes-that-old-refrain-11.jpg 574w, https://renal.platohealth.ai/wp-content/uploads/2023/09/here-comes-that-old-refrain-12.jpg 150w, https://gailraegarwood.files.wordpress.com/2022/08/pexels-photo-903171.jpeg?w=300 300w” sizes=”(max-width: 287px) 100vw, 287px”>

Photo by Andrea Piacquadio on Pexels.com

So, what to do about the fatigue? It’s hard to live with. One paper in the Clinical Journal of the American Nephrology Society [CJASN] offers the following:

“The approach to a patient with fatigue should begin with an assessment of factors where one might be able to intervene. These include recognition and treatment of anemia, sleep disorders, and depression. Targeting higher hemoglobin levels with ESAs [Gail again -Erythropoietin stimulating agents] has associated risks that preclude their indiscriminate use other than on an individualized basis. Interventions targeting depression have not yet proven convincingly beneficial for improving fatigue, but studies are ongoing. Sodium bicarbonate supplementation to treat metabolic acidosis may help improve fatigue and functional status. Physical activity is worth recommending in light of the additional benefits of exercise. “

One note on the above. This is the black box warning on ESA box according to Pfizer:

“WARNING: ESAs INCREASE THE RISK OF DEATH, MYOCARDIAL INFARCTION, STROKE, VENOUS THROMBOEMBOLISM, THROMBOSIS OF VASCULAR ACCESS AND TUMOR PROGRESSION OR RECURRENCE.

Chronic Kidney Disease:

  • In controlled trials, patients experienced greater risks for death, serious adverse cardiovascular reactions, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target a hemoglobin level of greater than 11 g/dL ….
  • No trial has identified a hemoglobin target level, ESA dose, or dosing strategy that does not increase these risks ….
  • Use the lowest RETACRIT dose sufficient to reduce the need for red blood cell (RBC) transfusions ….”

There are also specific warnings for cancer, and perisurgery [pre, during, and post operation].

Not being a doctor and having no medical training except what I’ve taught myself, this was one of the more difficult blogs to write. Here’s hoping I got it right but, as always, check with your nephrologist if you need help with any of this.

Until next week,

Keep living your life!

The URI to TrackBack this entry is: https://gailraegarwood.wordpress.com/2023/04/17/here-comes-that-old-refrain/trackback/

RSS feed for comments on this post.