When your chronic kidney disease (CKD) progresses to late-stage, or end-stage, kidney-disease (ESKD), you may experience certain symptoms as a result. What you may not know, however, is that all of these symptoms can be managed to improve your quality of life. In a webinar by the American Kidney Fund, Dr. Gopa Green, a clinical nephrologist and medical director of a dialysis center, and Diane Ruddell, a social worker at the same center, talk through the three most common symptoms that present in ESKD and how to manage them.* 

The three most common symptoms

Dr. Green kicked off the event with a discussion on the three symptoms that are most common in late-stage CKD patients.

1.  Dry and itchy skin, known as uremic pruritus

Uremic pruritus involves dry and itchy skin associated with kidney disease. It is often under-recognized, even though it is reportedly bothersome in about 18% of people with CKD. It’s associated with:

• Lower quality of life
• Depression
• Lower sleep quality
• Increased death rate

High phosphorus, not enough dialysis, and hyperparathyroidism are some possible factors associated with the condition and are areas that medical teams can modify to help relieve patients of the symptom.

Managing uremic pruritus

Dry skin sufferers should consider:

• Use a fragrance-free skin moisturizer daily, particularly after bathing
• Use mild cleansers when cleansing 
• Avoid cleansing the skin too much or washing too roughly.

As it relates to phosphorus, a reduction of phosphorus in the diet is often necessary. Phosphate binders can eliminate phosphorus and should be taken with meals. 

Some physicians may consider upping a patient’s dialysis dose to see if this improves dry and itchy skin, while other doctors may prescribe antihistamine medication to control itchy skin.

2.  Sleep disorders

Forty-four percent of CKD patients express having issues with sleep. Sleep disorders may include:

• Insomnia
• Excessive sleepiness
• Sleep apnea
• Restless legs syndrome (RLS)
• Periodic limb movement disorder (PLMD)

Insomnia (the inability to fall asleep or to stay asleep) creates a strong source of stress for patients and is associated with increased inflammation and mortality rates. Factors contributing to insomnia can include sleep apnea, RLS/PLM, metabolic factors (like uremia or anemia), and poor sleep habits (such as napping during the daytime). All factors should be explored by your care team.

Managing sleep disorders

By limiting daytime napping, aiming for a consistent sleep schedule, and limiting screen time before bed, individuals with kidney disease may find insomnia to occur less frequently. Melatonin or other doctor-recommended sleep aids may also help. 

In those with excessive sleepiness and sleep apnea (the inability to breathe properly during sleep), switching to nocturnal dialysis versus daytime dialysis may help reduce these symptoms. Leg disorders, such as RLS and PLM, can be improved with exercise and sometimes with fixing iron deficiencies.

Research shows that sleep disorders often occur during dialysis, but they may diminish in those with a kidney transplant.

3.  Fatigue, especially after dialysis

Fatigue includes low energy or feeling sleepy, and it can be worsened by:

• Depression
• Underdialysis
• Low physical activity
• Poor sleep
• Poor diet

In addition, dialysis can sometimes cause fatigue; one survey found that patients felt sleepy up to six hours after a dialysis session. Increasing dialysis may sometimes be the fix for excess fatigue.

Managing fatigue

To tackle fatigue, talking to your doctor about changing your dialysis schedule or type of dialysis may help. You may also want to explore depression and anemia testing (i.e., low iron levels) with your medical team.

Other helpful tips include:

• Eating small, healthy meals more often versus large meals
• Getting good sleep
• Reducing caffeine and alcohol intake
• Managing and reducing stress
• Engaging in physical activity, whether it’s walking, running, or cycling

Together, these changes can decrease fatigue and offer you more sustained energy throughout the day.

Other possible symptoms

While these three disruptive symptoms may seem unrelated to kidney disease and your dialysis treatment, there is a good chance they may be. They may not be the only symptoms you experience, however; anxiety, headaches, and nausea, among others, may also present in kidney disease patients.

Through the help of your care team, family, friends, and support groups, you can achieve a reduction in or elimination of unwanted symptoms that may arise in late-stage kidney disease.

*American Kidney Fund. (2019, Aug. 20). Managing Side Effects of Late Stage Kidney Disease. https://www.kidneyfund.org/training/webinars/managing-side-effects-of-late-stage-kidney-disease.html