Address Functional Status & Quality of Life Issues

Decreased functional status and QOL frequently complicate progressive CKD. This can occur well before the initiation of RRT. Common causes that need to be assessed and addressed to improve energy level and QOL include malnutrition, anemia, insomnia, depression, and lack of physical activity.

Malnutrition can occur in CKD patients due to poor appetite, metabolic acidosis, anemia, and protein-restricted diets among others. MNT is covered by Medicare for those with kidney disease. Referrals should be made to a registered dietitian with experience in CKD. See section on malnutrition.

Anemia may be associated with decreased cognition and mental acuity, weakness, fatigue, decreased endurance, and other symptoms reflecting reduced ability to complete activities of daily living and decreased QOL. See section on anemia.

Insomnia can lead to fatigue and decreased QOL. Patients with insomnia or who nap excessively throughout the day should be counseled on good sleep hygiene. Advise on making the bedroom more comfortable, using the bedroom for peaceful activities, setting up a bedtime routine, limiting naps during the day, and avoiding large meals or exercise 1 to 2 hours before bed. Restless leg syndrome, chronic pain, and sleep apnea may contribute to poor sleep. See more information on sleep disorders and restless leg syndrome.

Depression is common in any chronic disease, including CKD, and can be responsible for fatigue or decreased QOL. Patients can be screened easily through a self-administered tool, such as the Public Health Questionnaire (PHQ)-9 questionnaire (PDF, 484 KB) . Any of the health care professionals involved in the patient's care can administer the screening. Although treatable, depression is commonly overlooked by health care providers.

Lack of physical activity can lead to fatigue. Physical activity during the day can help people sleep deeper, longer, and feel more refreshed when they wake up.