Anemia of Chronic Kidney Disease

Topic Overview

What is anemia of chronic kidney disease?

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 anemia of chronic kidney disease?

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 working at one-third or less of their 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 anemia of chronic kidney disease diagnosed?

Your doctor can check for anemia by doing two blood tests:

• Hemoglobin (Hgb) test. This test measures the level of hemoglobin in your blood. Hemoglobin is the substance in red blood cells that carries oxygen. This is the best test for anemia.
• Hematocrit (Hct). A hematocrit test shows your doctor how much of your blood is made up of red blood cells.

Your doctor will repeat these tests to see how well treatment is working.

How is it treated?

The two main treatments for anemia in kidney disease are erythropoietin (EPO) and iron.

• If tests suggest that your kidneys are not making enough EPO, you may need a man-made form of this hormone. It is called an erythropoietin-stimulating agent (ESA). This medicine is most often given as a shot under the skin (subcutaneous).
• To build the iron levels in your body, you may need to take iron pills or get iron through an injection into a vein (IV).

Both treatments can be given through an IV during dialysis.

Other possible treatments include:

• Vitamin B12 or folic acid supplements. You can take vitamin B12 by mouth, as a nasal spray or gel, or as a shot into the muscle. Folic acid comes in pill form.
• 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.