Lack of energy

My husband has been on PD for 10 months; prior to that he was on Hemo. He has no energy.and sleeps alot. He didn’t have energy on Hemo and it’s the same with PD. His doctors can’t explain it. All his blood tests are excellent; his kt/v is 1.75. His kidney doctors say his lack of energy is not due to the dialysis/ kidney failure.

My husband also has atrial fibrillation and takes amiodarone and coumadin. He is not diabetic; his blood pressure is about 100/65.

He has had balance problems and diagnosed with cervical myelopathy.

He is not depressed. He has a good sense of humor and is very alert. His stamina lasts about 2 hrs then he becomes very tired and has to rest /sleep( for about an hour). This does not interfere with his sleeping at night.

I am concerned because every doctor (specialist) refers me to another doctor and no one can find anything.

Any suggestions from anyone?

Hi Js3fish,

A couple of thoughts. Some doctors believe that a deficiency of l-carnitine can be caused by dialysis and may lead to fatigue. Since carnitine is available, it may be worth asking your husband’s doctor to test him for this.

Is he also taking a statin drug for high cholesterol? Statins deplete co-enzyme Q10, and defiency of this enzyme can also cause fatigue (and heart failure).

Most likely, I suspect–as a non doctor is that he has deconditioning. He’s been sedentary for so long that his muscles are weak and he doesn’t have much stamina. It sounds a little crazy to think that exercising will make him feel better when he’s so tired now, but believe it or not, this can be true. A lot of us think about the body as being like a flashlight battery–when we run down, we get tired and worn out. But the body is really more like a rechargeable battery, and exercise is what recharges us. The MEI has a free exercise resource through our Life Options program that you can download, read, and talk with your husband’s doctor about. You can get it at:

That’s what I was going to say. I am on PD, and have been for a year. I am also on coumadin and have many other medical problems, and I am only 19! Sometimes when I sleep too much one night, I feel crappy until I start sleeping less. I try to only sleep 8 hours or less a night, and it actually makes me feel a lot better! I don’t really exercise much, but I’m sure it would help too. My suggestion is to not let him sleep so much. It seems to help me, but everyone is different. Maybe give it a try?

Thanks for your recommendations. I will try to get him to exercise more and sleep less.

He is not on any drugs for high cholesterol.


As a social worker, when I hear that someone has no energy and sleeps a lot, I think of depression. You say that he’s not depressed and has a good sense of humor. It’s possible that even he doesn’t recognize that he is depressed or grieving over the loss of his kidneys and the changes in his life. Or it’s possible that he knows he feels sad but tries to cover it up by saying he’s fine and showing his “good sense of humor.”

Here’s an online depression screening tool from the NYU Med Center/NYU Dept of Psychiatry that he could complete by answering the questions honestly and having the tool score the test letting him know if he’s depressed. If so, he should get a psychiatric evaluation and treatment.

If he is depressed, activity/exercise can help along with medications and talk therapy. Cognitive behavioral therapy has helped people with depression. His social worker should be able to provide some counseling but if he needs more time, he/she or his nephrologist may be able to refer him to a community psychiatrist, psychologist, or social worker who has worked with people with chronic illnesses, like kidney disease.

You and he may want to review the Kidney School module on Coping with Kidney Disease (Module 5).

Good luck!

…or the Kidney School module on Staying Active.

If he does decide to do exercise (which also helps with depression), it’s a good idea to check in with his doctor first to be sure there aren’t any restrictions. Generally, starting slow and building up gradually are best.

well i would advice you to go for thyroid test as well.
My father also compained of lack of energy and weakness .
he was otherwisw very fine and doing very well on all the other aspect of dialysis.
hypothyroidism can be the possible cause.
i m very surprised i along with my father searched interneyt since april 04 but very few articles are there on the connection between thyroid problem and dialysis.

I have thyroid problems and kidney problems, but I don’t think there is a link bt them. I had hyperthyroidism 2 years before I started dialysis. I had my thyroid shutdown by radio-iodine therapy and am now on replacement hormones for life.

Amniodorone can affect the thyroid quite significantly - have his MD check for this. Several of my PD pts are on this med and it has affected the thyroid gland. KT/V of 1.75 is not great - should be 2.0 for CAPD, 2.2 for CCPD. I also agree that he needs to begin exercising more.

Thanks, JerseyGirl! I did look up that drug, and it does have a lot of possible side effects, but that thyroid connection is a really good point–as is the Kt/V. Now I wonder about his drains. Wouldn’t removing too much fluid cause fatigue?

Regarding his kt/v…his doctor said there are new guidelines and a 1.70 or above is now acceptable so he did not change his prescription. He is on a night cycler and also does one midday exchange.

When he was on hemo I believe they were taking off too much fluid. He looked terrible. Since being on PD he put on 20 lbs and is back to his pre-illness weight. He feels comfortable with his fluid levels now.

He does take synthroid for hypothyroidism. Maybe this is the source of the weakness/lack of energy.

He does about 15 minutes of physical therapy each day to strengthen his leg and back muscles because of his balance/ walking problems due to cervical stenosis.

Just wanted to mention that I also take synthroid (100mcg/day) and it doesn’t make me weak/tired, but everyone is different, I guess.

It may not be the synthroid itself, Shay, it may be that his dose needs to be changed (probably increased) due to the effects of the amiodarone on his thyroid. It sounds as if getting his thyroid checked again would be a really good step.

While a KT/V of 1.7 may be “acceptable” it IS pretty low. I shoot for higher when figuring out patient prescriptions. BP sounds alittle low as well - systolic of 100 - he may need alittle higher BP - maybe he is pulling off too much fluid - what dextrose does he use?
What are his fill volumes? If he has a sitting BP of 100 check for orthostatic changes - he may be alittle too weak to do much at that; if he stands you may find quite a drop in blood pressure.

Also as another thought, his target weight may have to be raised because he is gaining weight as well. Good luck!

Yeah, my Kt/v is over 3 and has been since I have started dialysis. It has gradually dropped just a little but has maintained it’s above 3 number.

My husband generally uses 2.5 solution. If we use a lower solution he starts to show swelling in his feet/ankles because we’re not pulling off enough fluid. On the night cycler he uses two 5000ml bags. He has three complete cycles with a fill of 2600ml and a last fill of 2000. Then he does a mid-day exchange with a 2000ml bag.His net UF from the cycler is usually around 1200 ml; his mid-day is about 2100 - 2200ml (this includes the 2000ml so he only takes off an excess of 100-200ml at midday.)

How do we get his blood pressure higher? He has always had blood pressure that is low. He does not experience any dizziness or weakness on standing?

What has to happen to improve his kt/v?

all i want to say that a kidney patient on dialysis can have some problem which are directly not related to kidney disease or dialysis .
he/she can have some disease whih even a common man can have.
lack of energy,loss of appetite ,low blood pressure and many other things depend on too many things which are beyond nephrology.
no harm in going for thyroid test.
My neph[father neph} stressed too much on dialysis ,anemia which were otherwise ok.
his KT/V was 2.0 and had ideal hemoglobin level but he had complete loss of appetite which was due to hypothyroidism which remain undetected till two days before his death.
His neph,baxter clinical team even internet{leading kidney desaease website ] failed to utter the word thyroid.

Thanks; excellent point. I will follow up with another thyroid test. His last test was in December.

My husband was tested for thryroid and his prescription was not increased, but the big difference came with a testosterone test. His was very low and his doctor gave him a testosterone shot. Within 36 hours after the testosterone shot his overall energy and feeling of well-being increased. While he still gets tired, I think that the testosterone shot has made a improvement in his day to day living. He will get another shot in 30 days.