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One of the most common – and most overlooked – symptoms of kidney failure is anemia, which manifests as fatigue. Essentially, kidney damage reduces the production of EPO, an important hormone that maintains the steady production of red blood cells. Less EPO means fewer red blood cells, and fewer red blood cells mean less oxygen is available to energize your cells and tissues. Since fatigue is such a general and common complaint, it’s easy to ignore this symptom of kidney failure.