Anaemia is a common complication of chronic kidney disease (CKD). It occurs when the kidneys fail to produce enough erythropoietin (EPO)—a hormone essential for red blood cell production. This leads to a reduced number of red blood cells, lowering the blood’s ability to carry oxygen.
Anaemia of kidney disease is not only a marker of worsening kidney function but also a major contributor to fatigue, poor quality of life, and increased risk of cardiovascular disease. Early recognition and treatment are crucial in improving patient outcomes.
The kidneys are vital for more than just filtering waste; they also play a key role in blood formation.
Erythropoietin (EPO): Specialized kidney cells produce this hormone in response to low oxygen levels in the blood. EPO stimulates the bone marrow to produce red blood cells.
Red Blood Cells (RBCs): These carry oxygen throughout the body. A deficiency results in anaemia, causing oxygen deprivation in tissues.
Chronic Kidney Disease (CKD): As kidney function declines, EPO production falls, leading to anaemia. Additionally, CKD patients often experience iron deficiency, shortened RBC lifespan, and blood loss during dialysis, which worsen anaemia.
Anaemia in kidney disease usually arises from multiple factors:
Reduced EPO Production – Damaged kidneys fail to release sufficient erythropoietin.
Iron Deficiency – Due to poor absorption, restricted diets, or chronic blood loss (especially in dialysis).
Shortened Red Cell Lifespan – In CKD, toxins accumulate and damage RBCs.
Blood Loss – Frequent blood tests and dialysis can lead to gradual loss of blood.
Nutritional Deficiencies – Lack of folate or vitamin B12 contributes to anaemia.
Inflammation – Chronic inflammation in CKD disrupts iron utilization and suppresses bone marrow function.
Anaemia often develops gradually, and symptoms may be mistaken for general CKD fatigue. Common signs include:
Persistent tiredness and weakness.
Shortness of breath, especially with exertion.
Pale skin or mucous membranes.
Dizziness, lightheadedness, or fainting spells.
Cold hands and feet.
Reduced exercise tolerance.
Palpitations or chest discomfort (from strain on the heart).
In severe cases, untreated anaemia increases the risk of heart failure, cognitive impairment, and overall reduced survival.
Diagnosis involves a combination of history, examination, and laboratory investigations:
Clinical evaluation: Fatigue, pallor, exercise intolerance.
Blood tests:
Complete blood count (CBC): Low haemoglobin (Hb <13 g/dL in men, <12 g/dL in women).
Serum ferritin and transferrin saturation: To assess iron stores.
Vitamin B12 and folate levels.
Kidney function tests: Serum creatinine, estimated GFR (eGFR).
Erythropoietin levels: Sometimes measured to confirm inadequate production.
Additional tests: Inflammatory markers or stool tests if blood loss is suspected.
The goal of treatment is to increase haemoglobin levels, relieve symptoms, and reduce complications.
Non-surgical / Medical Treatments
Erythropoiesis-Stimulating Agents (ESAs): Synthetic versions of EPO (e.g., epoetin alfa, darbepoetin) stimulate the bone marrow to produce RBCs.
Iron Supplementation:
Oral iron (ferrous sulfate, ferrous fumarate).
Intravenous (IV) iron for dialysis patients or those intolerant to oral forms.
Nutritional Supplements: Vitamin B12 and folate correction if deficient.
Blood Transfusion: Reserved for severe anaemia not responsive to other measures, though used cautiously due to risk of complications and transplant rejection.
Advanced / Procedural Treatments
Dialysis Optimization: Improving dialysis adequacy can reduce toxin buildup that worsens anaemia.
Kidney Transplantation: Restores normal EPO production and often corrects anaemia.
Erythropoiesis-Stimulating Agent (ESA) Administration:
ESAs are given either subcutaneously (under the skin) or intravenously (IV) during dialysis.
Dosage is tailored to maintain haemoglobin within a safe target (usually 10–12 g/dL).
Regular monitoring is essential to avoid excessive haemoglobin rise, which may increase cardiovascular risks.
IV Iron Infusion:
Administered in dialysis units or hospitals.
Delivered slowly to reduce risk of allergic reactions.
Improves ESA response and replenishes iron stores.
While not a surgical condition, anaemia correction requires careful long-term monitoring and follow-up care:
Regular blood checks: Haemoglobin, ferritin, and transferrin saturation.
ESA dose adjustments: Based on haemoglobin trends.
Dietary guidance: Iron-rich foods (lean meat, leafy greens, beans), vitamin B12, and folate sources.
Dialysis patients: Monitoring for blood loss and optimizing dialysis efficiency.
Patient education: Recognizing early symptoms of worsening anaemia and adherence to treatment schedules.
If not properly managed, anaemia of kidney disease or its treatments may cause complications:
Untreated anaemia: Heart enlargement, heart failure, reduced cognitive function, increased mortality.
Iron therapy risks: Constipation (oral), allergic reactions (IV).
ESA-related risks: High blood pressure, increased risk of clotting, stroke, or cardiovascular events if haemoglobin rises too quickly.
Blood transfusions: Risk of iron overload, infection transmission, and sensitization (complicating future transplants).
With proper treatment, most patients achieve improved haemoglobin levels, better quality of life, and reduced cardiovascular risks.
Mild to moderate CKD: Early treatment with iron and ESAs can prevent severe complications.
Advanced CKD or dialysis patients: Continuous therapy is often required, but outcomes are significantly improved with adherence.
Post-transplant patients: Anaemia often resolves once kidney function is restored.
You should consult a healthcare professional if you have kidney disease and experience:
Persistent fatigue or weakness.
Shortness of breath or palpitations.
Pale skin or unexplained dizziness.
Worsening symptoms despite regular dialysis.
Early intervention is key to preventing complications and improving long-term health.
Anaemia of Kidney Disease is a common but treatable complication of CKD. It results primarily from reduced erythropoietin production, iron deficiency, and shortened red blood cell lifespan. Diagnosis relies on blood tests, and treatment typically involves ESAs, iron supplementation, and nutritional support.
Left untreated, it increases the risk of heart disease, poor quality of life, and higher mortality. With proper management and regular follow-up, patients can maintain healthier haemoglobin levels and significantly improve their well-being.
If you have CKD or symptoms suggestive of anaemia, consult a healthcare provider for timely evaluation and treatment.
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