What is Anemia and Kidney Disease?

Anemia tends to develop in about 12% of patients with Chronic Kidney disease (CKD).  Progressing stages of CKD tend to elevate the risk of developing anemia. Those found to be more likely to develop the disease are:

  • People of African descent
  • Females
  • Individuals diagnosed with diabetes

What are Red Blood Cells (RBCs)?

Red blood cells are a major component of the blood; they transport oxygen from the lungs to the rest of the organs and carbon dioxide from the other organs back to the lungs so that it can be expired. Red blood cells are required to keep the organs alive and healthy.

What is the function of the Kidneys?

Kidneys are the filters of the body. They remove any waste products present in the blood in the form of urine in order to protect organs from being damaged. They are vital organs that keep the body’s internal environment at its optimum condition.

The kidneys are also vital to maintaining the required amount of red blood cells. They produce a hormone known as erythropoietin (EPO) which signals the body to produce more RBCs. Should this supply of EPO deplete, for example as a result of chronic kidney failure, RBC production will fall dramatically leading to a condition known as anemia.

What is Anemia?

Anemia is a condition caused by a lack of red blood cells in the blood. This means the body has to work harder to get the organs the oxygen they require to function normally. An anemic patient will experience symptoms such as:

  • Fatigue
  • Weakness
  • Shortness of Breath
  • Increased heart rate
  • Chest pain
  • Poor sleep
  • Poor appetite
  • Lightheadedness
  • Palpitations (Can feel your own heart beat)

Anemia can originate from problems other than chronic kidney disease such as:

  • Iron Deficiency (most common)
  • Vitamin B12 Deficiency
  • Folic Acid Deficiency
  • Excessive blood loss

What are some lab tests for Anemia?

  • Complete Blood Count (CBC) – The doctor may order this exam to check the amount, size and quality of RBCs in the body. In addition to RBCs, this test also looks at other types of cells in the blood such as white blood cells (WBCs) and platelets. A CBC will tell the doctor whether or not you have anemia and may point towards the cause.
  • Peripheral Blood Smear - This is a diagnostic test that gives the doctor a picture of RBC shape and size in the blood. This test also looks at other types of cells within the blood such as WBCs and platelets.
  • Reticulocyte Count – Reticulocytes are the baby (precursor) RBCs in the blood. This gives the doctor an idea of the amount of newly produced RBCs. The test will point towards the origin of the problem; a kidney defect may increase the reticulocyte count whereas a problem in the bone marrow may decrease it.
  • Iron Panel – This test tells the doctor the amount of iron that is in your body. Iron is required to produce RBCs in the body. It can help rule out causes of anemia other than CKD. It measures four different values, each interpreted differently by your doctor: Serum iron, Ferritin, Total Iron Binding Capacity (TIBC) and Iron Saturation.

What is the treatment of Anemia caused by CKD?

  • Erythropoiesis Stimulating Agents (ESAs) – These are drugs that will stimulate the production of RBCs in your bone marrow (the factory of RBCs, WBCs and platelets). Their main advantage is the reduced requirement of blood transfusions which can leave a patient in an iron overloaded state.
  • Iron – This is required by the bone marrow to make RBCs in your body. Without Iron all RBC production will cease even if you are given ESAs.
  • Red Blood Cell Transfusion – These are usually not required unless the hemoglobin count falls dangerously low.
  • Vitamin B12 or Folic Acid Supplements – Both these vitamins are required in the process of creating RBCs in your body. These may be prescribed to restore adequate amounts of these vitamins.
  • Triferic – This newly FDA approved drug is reportedly removing the need for post dialysis Iron therapy. The solution contains a dissolved form of Iron that is administered to a patient via a dialysis machine.

Disclaimer: The UCLA Health System cannot guarantee the accuracy of such information. The information is provided without warranty or guarantee of any kind. Please speak to your Physician before making any changes.