What is anemia of chronic kidney disease?
Anemia of chronic kidney disease means that kidney disease has caused your anemia. Your doctor will have ruled out other causes of anemia.
Anemia means that you do not have enough red blood cells. Red blood cells carry oxygen from your lungs to your body's tissues. If your tissues and organs do not get enough oxygen, they cannot work as well as they should.
Anemia is common in people who have chronic kidney disease. It can make you feel weak and tired. With treatment, you may feel better and enjoy life more.
What causes it?
Red blood cells are made by the bone marrow. To get the marrow to make red blood cells, the kidneys make a hormone called erythropoietin, or EPO. When the kidneys are damaged, they may not make enough EPO. Without enough EPO, the bone marrow does not make enough red blood cells, and you have anemia.
In most cases, the more damaged the kidneys are, the more severe the anemia is. In general, people whose kidneys are not working at the normal level may get anemia.
What are the symptoms?
Anemia may develop early in kidney disease, but you may not have symptoms until the late stages of the disease.
As anemia gets worse, you may:
- Feel weak and tire out more easily.
- Feel dizzy.
- Be irritable.
- Have headaches.
- Look very pale.
- Feel short of breath.
- Have trouble concentrating.
How is it diagnosed?
Your doctor can decide if you have anemia of chronic kidney disease when you have both anemia and chronic kidney disease and there is no other reason for anemia.
Your doctor will do blood tests, including a complete blood count (CBC), to learn about your red blood cells and possible reasons for your anemia.
How is anemia of chronic kidney disease treated?
The first step to treating anemia in kidney disease is to address any fixable causes of anemia, like low iron. Many people need iron. Iron can be given as a pill or through an intravenous (I.V.) line in a vein. If you get hemodialysis, I.V. iron is usually the first choice and is given during dialysis.
If your iron level stays low after iron treatment, your doctor may use a human-made hormone called an erythropoietin‑stimulating agent (ESA). This is usually given as a shot under the skin or through the dialysis line. Your doctor will use the lowest dose of ESA or other anemia medicine needed. The goal is to keep your hemoglobin below about 11.5 grams per deciliter (g/dL) so that treatment is safer for your heart and blood vessels.
Some people may get a newer type of anemia medicine called hypoxia-inducible factor–prolyl hydroxylase inhibitors (HIF-PHIs). These are pills that help your body make more red blood cells. Your doctor may use these if ESA shots are not working well or are not a good choice for you.
Other possible treatments include:
- Diet changes. Ask your doctor if eating more foods high in iron, folic acid, and vitamin B12 could help your anemia. But don't make changes to your diet until you talk to your doctor first.
- In rare cases, a blood transfusion. A blood transfusion gives you new blood or parts of blood you need, such as red blood cells. But this is done only if your anemia is severe.
