No energy on PD

My husband was on Hemo dialysis for 1 yr. Two months ago he switched to PD. He is currently on manual 4 times a day. In October he will go on the night cycler. One reason he chose PD is because he had heard that you have more energy on PD. While he likes the freedom and the less restrictive diet, his energy level is VERY low. He takes many “naps” each day, and is very tired. His monthly blood tests show that everything is within the “normal” range. We’re trying to figure out why he’s so tired all the time. He wants to get back to some of his hobbies (we’re retired - he’s 71) but doesn’t have the energy. Can anyone give us any idea on what to do or does he have to expect this lack of energy as a result of ESRD.


Hi j3fish, and welcome to Home Dialysis Central. I’m glad you found your way here, and thanks for joining!

It sounds as if your husband was fatigued on in-center hemo and is still fatigued on PD. Is that right? We are NOT doctors, but I do wonder about a couple of things:
– How is he sleeping at night? You mention that he takes many naps during the day–and this is something that can interfere with nighttime sleeping, so that then he doesn’t get enough rest, and it’s hard to catch up. When you feel really, really fatigued, it’s hard not to take those naps, but if he could even start to cut back on some of them, it might help.

– Does he ever get any physical activity? People who are on dialysis actually get more run down and lose more normal muscle tone than healthy people, and their tendency to “take it easy” and avoid all exercise makes it worse. In the LIfe Options program, which we at the non-profit Medical Education Institute also run, we like to say that “the body is like a rechargeable flashlight, and exercise is what recharges it.” Clearly, your husband is very tired, and he would need to start VERY slowly. But if he doesn’t “use it” he’ll keep “losing it.”

I suggest that you read the “Staying Active” module of Kidney School, the on-line kidney learning center that is part of Life Options. That module covers fatigue, sleep issues, and physical activity, and may give you a place to start. You can visit Kidney School at

Other chronic diseases can also cause fatigue. You didn’t say what the cause of his kidney failure was, but diabetes, for example, can cause fatigue. So, a talk with his doctor might be in order, especially if none of these other ideas does the trick–but do give Kidney School a try.

Like Dori said, sleeping at night and limiting naps during the day and getting some exercise could help. Some other things to consider:
– You say his lab values are in the “normal” range. What is his hemoglobin level? If it’s low normal he could still be feeling tired.
– How is his appetite, especially for protein? If he’s not eating enough protein he could feel weak and tired too. PD removes more protein than hemodialysis. He could talk with the dietitian about his nutritional status and what he can eat to increase his protein.
– Does he snore or seem to stop breathing when he’s sleeping? Sleep apnea can prevent someone from getting good sleep so they’re often tired. A sleep study could tell if he has this problem.

What were his kt/v’s on hemo? What kind of hemo access did he have? Perhaps he was chronically underdialyzed on hemo and is “catching up” now that he is on PD. What is his cardiac status - specifically his ejection fraction? If he has background cardiac disease maybe he has poor baseline cardiac function to begin with. I agree with Dora and Beth he needs to begin exercising - slowly. Indeed, “if you don’t use it you lose it” as far as exercise. Dialysis is not a cure all. Comorbid conditions play a huge part in how the patient feels. Regarding PD is he taking off too much fluid? Perhaps he is dehydrated. How about his serum potassium? That tends to drop on PD. Have your center check it. Low potassium or high potassium can affect how a patient feels as well. My patients do feel better on PD, especially the ones that did hemo before switching. Hang in there!

Thanks for the referral on Stay Active in Kidney School. Will check it out. My husband’s kidney failure was caused by TTP (rare blood disorder) which was “cured”. He is not diabetic. He has atrial fibrillation but no other cardiac issues. He drinks Nepro to maintain his protein level which is on the lower end of normal. He is not anemic. Potassium level has been fine. Takes Renagel with meals. He was dehydrated while on Hemo, but not since he is on PD. He has gained weight and is almost back to his normal weight before he got TTP which resulted in kidney failure. I think exercise is the answer. Thanks so much!