Understanding Fatigue in IgAN: Causes and Management

Oct 10

Fatigue is a very common and often debilitating symptom of IgA nephropathy (IgAN). It is linked to disease progression and reduced kidney function, but other factors like inflammation, anemia, and mental health also play a role. In a 2025 study, the majority of patients with IgAN reported fatigue, and patients with more severe proteinuria and lower kidney filtration rates (eGFR) experienced worse fatigue.

Causes of Fatigue

The exact mechanism is not fully understood, but multiple factors associated with chronic kidney disease (CKD) contribute to fatigue in IgAN patients:

Anemia: Impaired kidney function reduces the production of erythropoietin, a hormone that stimulates red blood cell production. This leads to anemia, or a shortage of red blood cells, which decreases the amount of oxygen transported to the body's tissues, causing weakness and exhaustion.
Waste buildup: As kidney function declines, waste products and toxins accumulate in the blood (a condition known as uremia). This buildup affects multiple body systems, including cellular energy production and brain function, leading to physical and mental fatigue.
Inflammation: Chronic inflammation is a hallmark of IgAN. This triggers the release of proteins called cytokines, which can interfere with energy metabolism, sleep quality, and muscle function.
Electrolyte imbalances: Impaired kidney function can lead to metabolic acidosis (an acid-base imbalance) and hyperphosphatemia (high phosphate levels). These conditions can disrupt muscle function and cellular energy, contributing to fatigue.
Sleep disturbances: Many patients with CKD experience poor sleep due to issues like restless legs syndrome, sleep apnea, or frequent itching. These disorders can significantly contribute to daytime fatigue.
Mental health: The stress of living with a chronic illness can cause emotional fatigue. Depression and anxiety, which are common in patients with IgAN, can further compound feelings of tiredness.

Management Strategies

Managing fatigue in IgAN involves addressing the underlying causes and adopting lifestyle changes.

Treat underlying conditions:

Anemia: If blood tests reveal anemia, a doctor may prescribe iron supplements or erythropoietin-stimulating agents (ESAs) to increase red blood cell production.
Metabolic imbalances: Addressing metabolic acidosis or hyperphosphatemia with medication or diet adjustments can improve fatigue.
Sleep disorders: If sleep apnea or restless legs syndrome are present, a doctor can prescribe a device or medication to help.

Adjust medication: Review all medications with your doctor to identify any that may be contributing to fatigue. This is especially important for patients who have had a kidney transplant, as immunosuppressants and other drugs can affect energy levels.
Incorporate physical activity: Regular exercise, even low-impact activities like walking, can improve fatigue and overall quality of life. It is important to find a balance and listen to your body, as fatigue may vary from day to day.
Prioritize sleep hygiene:

Routine: Establish a consistent sleep schedule by going to bed and waking up at the same time each day.
Environment: Make your bedroom dark, quiet, and cool.
Stimulants: Avoid caffeine, large meals, and alcohol before bedtime.

Improve nutrition:

Balanced diet: Focus on a kidney-friendly diet with plenty of fruits, vegetables, whole grains, and lean proteins.
Sodium and protein: Limiting sodium and managing protein intake can reduce stress on the kidneys and help control blood pressure.

Manage stress: Techniques like meditation, deep breathing, and spending time on hobbies can help manage the emotional toll of IgAN. Consider talking with a mental health professional or joining a support group.
Practice energy conservation: For more severe fatigue, prioritize tasks for the times of day you feel most energetic. Take regular breaks and be realistic about what you can accomplish.