Excessive tiredness and PD?

My husband had a bout of pneumonia a month ago and has yet to rebound physically. He is now on short term disability (at 26). He seriously spends all but a few fleeting moments in bed and I have had to take over most of his dialysis care. He can get out for a few hours, but sleeps during the car ride. He is also not really hungry and he has no anemia issues (as of a few weeks ago). Any ideas to why he is so tired?

I plan to call the doctor tomorrow.


Hi Lawphi,

Calling the doctor seems reasonable. Certainly pneumonia can knock the stuffing out of you, but there could be other things going on, too:
What are your husband’s protein levels (serum albumin)? If he is malnourished–and I worry about that with his lack of appetite and being on PD, which can leach protein out of the body–he would be fatigued and losing muscle mass.
Is he getting enough PD? Over time, residual kidney function can drop and the PD dose may need to be increased to make up for the loss. If this doesn’t happen, it can lead to fatigue and muscle weakness. In some cases, PD just can’t give enough filtering and a switch to home hemo could make a huge difference.
Is he deconditioned? It seems backwards to think that someone who is sooo tired should exercise, but even in bed, if he could use small weights and Therabands and start to rebuild muscle, he would likely be quite a bit better off. It doesn’t take long to have muscle wasting when someone is bedridden, and a month is long enough to make him significantly weaker. I would ask the doctor about physical therapy, too.

seems a long shot but its probably something you should look at.

sleep study will give you an answer if this is the cause.

A sleep study has been suggested before and now is a possibility with him being off work. He does have restless leg issues and takes medication to help him sleep.

All his protein levels/blood cell levels were fine last month. However, I am sure things can quickly change.

He seems to have a little more energy over the last 48 hours. He was able to do a few errands and hung out on the couch for a while.

Did you call the doctor or the PD nurse? I’m glad to hear that he’s had a bit more energy the last couple of days, but it’s also possible that too much water is being taken off by PD. Being dehydrated can make someone very tired.

Having restless legs syndrome (RLS) can be a sign of not getting enough dialysis. One study found that RLS was significantly reduced after a transplant–which suggests that poor toxin removal from dialysis may be part of the problem.

Unfortunately, for people on dialysis, a study of 894 patients found that severe RLS was a risk factor for lower quality of life and a higher risk of death. (Unruh ML, Levey AS, D’Ambrosio C, Fink NE, Powe NR, Meyer KB; Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study. Restless legs symptoms among incident dialysis patients: association with lower quality of life and shorter survival. Am J Kidney Dis. 2004 May;43(5):900-9.)

People who are not on dialysis can have sleep problems. They can have RLS. It can be hard to sort out whether sleep issues are related to dialysis or not–but I would err on the side of caution and assume that they ARE. A sleep study can show what you already know–that your husband has poor sleep quality and RLS. If it were my husband, I would be talking with the nephrologist about testing adequacy of his dialysis and whether it might be time to increase his PD prescription or switch to daily or nightly home hemo. Is he on the transplant list? If he’s eligible for a transplant, that could also be a good option.

Another thing that could be causing his fatigue, lack of appetite, and sleeping most of the time could be depression. Depression is too common and often undiagnosed in people on dialysis, especially those who have recently started treatment or those who have had a health setback. His dialysis clinic has a social worker who is not only there to help with financial issues, but to help people cope with having a chronic illness and needing to do dialysis. He/she would be a good person to talk with about his concerns and his hopes and dreams for the future. Perhaps they can work together with you and your family to help him succeed.

Here is a fact sheet about depression from the National Institute of Mental Health, a government agency: