Iron Deficiency Anemia in Chronic Kidney Disease

Chronic kidney disease (CKD) happens when the kidneys are damaged and cannot filter blood properly. CKD can cause waste and fluid to build up in the body, along with other complications. About 1 in 7 people with CKD also have anemia.¹

What is anemia?

Anemia means you do not have enough red blood cells or hemoglobin. Hemoglobin is a protein that allows red blood cells to carry oxygen around the body. Anemia stemming from too little hemoglobin is called iron-deficiency anemia. This is because hemoglobin contains iron, and the body needs iron to make it.^1-3

Anemia can cause your organs to get too little oxygen, which can lead to complications. Symptoms of anemia can include:^1-3

• Tiredness
• Shortness of breath
• Dizziness or fainting
• Rapid heartbeat
• Looking pale
• Poor appetite
• Trouble sleeping
• Headaches

What is the link between chronic kidney disease and anemia?

The kidneys make a hormone called erythropoietin (EPO). Hormones are chemicals that carry messages around the body. EPO carries the message telling your body to make more red blood cells. With CKD, the kidneys cannot make enough EPO. Low EPO leads to your body not making enough red blood cells.^2,3

CKD also may cause anemia in other ways, including:^2,3

• Iron deficiency, which means your body may not have enough iron to make hemoglobin
• Blood loss, especially if you are on dialysis
• Lack of other nutrients needed to make red blood cells, like vitamin B12 and folate
• Infections or inflammation

Anemia becomes more common as kidney disease progresses. Almost everyone who has progressed to kidney failure has anemia. People with diabetes and those over age 60 are also more likely to develop anemia.^2,3

How is anemia diagnosed?

Not everyone with anemia has symptoms. If you have CKD, you should get a blood test at least once a year. This test will measure the amount of hemoglobin in your blood. If your hemoglobin levels are low, it is likely that you have anemia. Your doctor will also use tests to identify the exact cause of your anemia, which can impact your treatment.^1,2

How is anemia treated?

Treatment for anemia can depend on the cause of it. If your anemia is caused by CKD, your treatment may include:^1-3

• Erythropoiesis stimulating agents (ESAs) – This is a type of medicine that helps your body make more red blood cells. These drugs are given as an injection.
• Additional iron – Iron helps your body make red blood cells and can help ESA drugs work better. You can take iron supplements or get iron transfusions. If you get dialysis, you may receive iron during your treatment.

In severe cases, you may need a blood transfusion. This treatment quickly increases your healthy red blood cell levels. But it can cause serious side effects, so it is not right for everyone.^1,2

Your doctor may also recommend diet changes. They may suggest a diet focused on foods that contain iron, vitamin B12, or folate. Talk with your doctor before making any changes to your diet.^1,2