COMMON KIDNEY DISEASE SYMPTOMS AND MANAGEMENT OPTIONS

Kidney disease can affect many aspects of your health. These complications may be caused either by kidney disease itself, or by its treatment (e.g., side‐effects of medications). Even if you are on dialysis or have had a transplant, you may experience symptoms. This fact sheet looks at common symptoms of reduced kidney function (presented in alphabetical order), outlines some possible causes, and discusses commonly used treatments.

Increasing your awareness about these possible symptoms associated with kidney disease is important because many of them can be prevented or reduced. Treatments are available for most of these symptoms, so don’t hesitate to talk to your health care team if you have a symptom that is bothering you. You may be asked to regularly complete a symptom assessment tool so that your health care team can monitor how symptoms are affecting you. You may also be referred to symptom management specialists if a symptom is particularly difficult to manage. 

ANEMIA

Anaemia can lead to feelings of tiredness, shortness of breath, dizziness, depression, confusion, feeling cold, trouble sleeping, and lack of appetite. This is because there are not enough red blood cells in your blood to carrying oxygen around the body.  

For those with kidney disease, these are some of the common causes of anaemia:
 Low levels of erythropoietin (EPO). This is a hormone produced by working kidneys that tells the bone marrow to make red blood cells  
 Lack of iron, vitamin B12 or folic acid  
 Blood loss – due to repeated blood tests, surgery and dialysis
 High levels of parathyroid hormone (see bone disease)
 Medications ‐ antibiotics, anti‐inflammatory or anti‐coagulant medications

Suggested treatments:

For people with kidney disease, the most common treatment is injections of an artificial erythropoietin. Many people are taught to give themselves this injection and find it easy and convenient.   

Iron deficiency is managed by injections of iron, and for those on dialysis this may be a regular part of the treatment. Sometimes tablets of iron or folic acid are also given. If you experience any of the above symptoms, it is important to tell your health care team.

BONE DISEASE

Bone pain, weak bones that break easily, itchy skin, and joint pain are all signs of an imbalance in calcium and phosphate in kidney disease. Healthy bones need a balance of calcium and phosphate. This balance is partly controlled by vitamin D, a hormone usually made active by the kidney. Vitamin D helps to absorb calcium from food. When calcium and phosphate levels are not balanced, the body makes too much parathyroid hormone, which further damages the bones.

Suggested treatments:
 Depending on the cause of bone disease and your level of kidney function, your doctor may prescribe medication such as phosphate binders, calcitriol, and cinacalcet  Your renal dietitian may recommend changes to your diet, including phosphate restrictions  
 Some people may need surgery to remove their parathyroid glands to help to lower high phosphate levels and high parathyroid hormone levels
 If you are on dialysis, the length of time on dialysis as well as the dialysate can be adjusted to help to bring your calcium and phosphate levels into balance

CONSTIPATION AND DIARRHOEA

There are many causes of constipation and diarrhoea, which include having diabetes, infections, some medications, and specific bowel conditions. For those with kidney disease, being on dialysis and the associated diet and fluid restrictions may also alter bowel habits. Constipation causes stomach pain, bloating and nausea, while ongoing diarrhoea can cause many problems, so it is important to manage your bowels well.

Suggested treatments:
Depending on the severity of your bowel problem, your doctor may prescribe medication. A dietitian may be able to advise you on ways to safely increase the fibre in your diet. Gentle exercise also promotes regular bowel motions. You should talk to your health care team if your bowels continue to cause you concern as you may need to be referred to a specialist

INSOMNIA

Insomnia means having trouble falling asleep, staying asleep or not feeling refreshed after sleeping. There are many possible causes and suggested treatments for insomnia.  The treatment for insomnia will depend on the cause, so it is important to talk to your health care team to see if you need any tests to investigate this.  There are also medications that can help insomnia, but it is important to check with your health care team first as some may be harmful to your kidneys.

MOOD AND WELL-BEING

Mood disorders are commonly experienced by people at all stages of kidney disease. Depression, anxiety and stress can be a reaction to your diagnosis of kidney disease. Medication side‐effects can also contribute to the changes in mood and well‐being. Some mood disorders may be the result of physical changes caused by kidney disease. For instance, the build‐up of waste products in your blood can cause irritability, edginess, moodiness, memory loss, confusion, and difficulty sleeping. 

Suggested treatments:
There are many different therapies and medications that can help if you are feeling depressed, anxious or stressed. Your health care team can also investigate physical causes or possible medication side‐effects.

MUSCLE CRAMPS

Many people with kidney disease get muscle cramps, particularly leg cramps. Sometimes people experience cramps during or after haemodialysis, especially if their blood pressure drops following too much fluid being removed. 

Suggested treatments:
 Do stretching exercises
 Massage the cramp area
 Use a heat pad  
 Have a hot shower or bath
 Drink fluids (only if you are below your recommended fluid body weight)
 Wear comfortable shoes
 Make sure you keep to your fluid restrictions

Cramp relieving products or electrolyte supplements available at pharmacies may also be effective, but check with your health care team first.

NAUSEA, VOMITING AND LACK OF APPETITE

Feelings like you are going to be sick (nausea) and actually being sick (vomiting) are commonly experienced by people with kidney disease. There are many possible causes for this, such as build‐up of wastes and toxins in the body (due to not enough dialysis) or medication side‐effects.  

As well as impacting on quality of life, ongoing nausea, vomiting and lack of appetite can mean you are not eating enough food to stay healthy. Receiving adequate nutrition is important, so discuss treatment options with your health care team. 

Suggested treatments:

 If you are on dialysis and your blood results indicate that you may not be having enough dialysis, then you may need to change your dialysis regime
 Your health care team may need to exclude causes such as an infection, bowel diseases or constipation, which could make you feel nauseous
 There are numerous medications that may be effective in managing nausea and vomiting. Your health care team will work with you to find the most appropriate medication for you

You should also be referred to a dietitian to find ways to keep yourself well‐nourished (consider supplemental drinks) if the nausea and vomiting are ongoing.

PAIN

Body pain is commonly experienced by people with kidney disease. This pain may be musculoskeletal (in the muscles, bones or joints such as osteoarthritis), nerve pain such as pain in the feet and calves that may occur with diabetes, or tissue pain. 

Suggested treatments:
Medications can successfully manage pain. It is important that you discuss pain management with your health care team as some medications are not appropriate for people with kidney disease.

RESTLESS LEG SYNDROME

Restless leg syndrome (RLS) is a common movement problem of the nervous system. Your legs feel as if they want to exercise or move when you are trying to rest. It can make it hard to sleep and relax. Some people have described RLS as a crawling, creeping, prickly, tingling, itching, burning, pulling, or shock‐like sensation. The problem can vary from a minor irritation to a severe condition. You may find that your arms are also affected. The cause of RLS is not clear but there appears to be a problem with the function of a chemical in the central nervous system. Low iron levels or inadequate dialysis can worsen RLS.  

All people with RLS should be treated with iron replacement therapy. Other approaches which may be helpful include:
 Avoidance of aggravating factors such as caffeine, alcohol and nicotine
 Massage
 Warm baths
 Warm/cool compresses
 Relaxation techniques
 Exercise
 If on haemodialysis, short daily sessions seems to help some people

If RLS is occurring only occasionally and is not too troublesome, then the symptoms will usually get better in time. If RLS is occurring frequently and is severe, then medications can be considered and, generally, are helpful.   

SEXUALITY

Many aspects of kidney disease, including hormonal changes, tiredness, sleeping difficulties, medication side‐effects, and changes in your physical appearance, may cause changes in sexuality. Issues such as reduced sexual desire (also called libido), impotence or erectile dysfunction, and reduced ability to orgasm may all impact on your enjoyment of sexual intercourse.   

Suggested treatments: This is a personal topic and some people may not feel like talking about it or seeking further guidance. However, many patients do seek advice from their doctors and other members of their health care team. As with all medical problems, the best treatment really depends on the cause of the problem and personal preferences. It is important that you talk to someone who knows your health history and understands the medications that you are taking.  

There are many appropriate treatments that may reduce or even fully resolve your particular problem. However difficult it may seem, try to communicate your concerns and any treatment recommendations with your partner, so that you can start to resolve the sexuality issues that may potentially affect your relationship and life together.

SKIN AND HAIR HEALTH

Bruising

It is not uncommon for people on dialysis to bruise easily as waste products that are not removed from the body by the kidneys can affect the functioning of the clotting cells (called platelets). Medication used to thin the blood, or low platelet levels can also cause bruising.  

Suggested treatment:
 Check with your doctor to see if your medication may be causing the problem, or if your blood platelet levels are too low

Hair loss

Malnutrition (particularly low protein levels) can cause hair to break more easily and fall out.  Hair loss can also be linked to other causes, e.g., thyroid problems, zinc deficiency, medication side‐effects, or changes in dialysers.
Suggested treatments:
 Talk to your health care team about possible physical causes
 Talk to a dietitian experienced in kidney disease about your protein levels
 Treat your hair gently, e.g., don’t use perms, hair dyes, or tight rubber bands
 Get some tips from your hairdresser on how to manage thinning hair

Itchiness
Itchy skin or ‘pruritus’ is a commonly reported side‐effect of kidney disease. The cause of itching is not always known. There are a number of suggested treatments, including:
 Asking your health team to check that you are receiving adequate dialysis  
 Following advice about keeping phosphate levels under control
 Moisturising the skin (see the section on dry skin)
 Medications including gabapentin, pregabalin and Evening Primrose Oil
 Ultraviolet ‐B therapy
It is also worth checking to see if there is another cause of the itch, e.g., allergies or scabies.  

Skin dryness
When kidney function is reduced, skin glands produce less oil and perspiration. This makes your skin drier and can increase itchiness.
Suggested treatments:
 Talk to your pharmacist about lotions to improve dry skin, e.g., sorbolene or emollient moisturising lotions
 Use a non‐perfumed, moisturising soap
 Avoid skin contact with alcohol‐based products  
 Don’t use very hot water
 Use a soap‐free shower gel

TIREDNESS

Tiredness may be a direct result of your decreasing kidney function. It may also be due to medication side‐effects or other physical conditions, such as anaemia, depression, insomnia or sleep apnoea.
  
Suggested treatments:
Some people find that their energy levels improve once they start treatment for kidney disease. Talk to your health care team to rule out physical causes of tiredness or possible medication side‐effects. Dealing with tiredness may require prioritising your activities and being flexible and realistic in your expectations about what you can achieve each day. If sleep is poor, adopting some sleep etiquette techniques, such as no caffeine after lunch, no alcohol, not watching TV in bed, and relaxation techniques may help.

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