Depending on a dynamical energy market dominated by the influence of volatile energies, the operators of hydro-power plants are forced to extend the operating range of their hydraulic machines to stay competitive. High flexibility towards low-load, a rising number of start-ups and fast response times are required for better control of the electrical grid. The major downside of these operating regions is that pressure pulsations, which are induced by the means of flow phenomena, lead to higher fatigue damage regarding the runner. Therefore, site measurements in combination with numerical methods can be used to gain a deeper understanding of the runner lifetime. This paper presents a numerical approach to understand the critical operation zones and access fatigue damage, including steady state, unsteady and transient computational fluid dynamic (CFD) one-way coupled with a transient finite element method (FEM).