Anemia in end-stage renal disease

What type of anemia is common in people with kidney failure?

Patients on dialysis:

The majority of patients on dialysis have anemia. Anemia in dialysis patients is caused by having:

Less erythropoietin (EPO) than normal

All of the cells in your body live for a certain amount of time and then die. Your body is always working to make new cells to replace the ones that have died. Red blood cells live for about 115 days. Your kidneys help your body make red blood cells.

Healthy kidneys make a hormone called erythropoietin (EPO). EPO sends a signal to your body to make more red blood cells. If your kidneys are not working as well as they should or have stopped working, they cannot make enough EPO. Without enough EPO, your body does not know to make enough red blood cells. This means fewer red blood cells are available for carrying oxygen through your body, leading to anemia.

Less iron than normal

Iron is a mineral found in many foods, such as meats and leafy greens. Your body uses iron to make red blood cells. A common cause of anemia in people with ESRD is iron deficiency. Iron deficiency means you do not have enough iron in your body. It can be caused by not getting enough iron through your food. It can also be caused by losing blood, because iron is stored in your red blood cells.

Patients who have had a kidney transplant:

Patients who have had a kidney transplant are at higher risk for having anemia. Anemia in kidney transplant patients is caused by having:

Less erythropoietin (EPO) than normal

If you have a kidney transplant, sometimes the new kidney does not work as well as a kidney in a healthy person. If your new kidney is not working as well as it should, it cannot make enough of the EPO hormone, which leads to anemia.

Less iron than normal

When you have a kidney transplant, you lose blood during the kidney transplant surgery. You will also have blood tests often to check on the health of your new kidney. Blood loss from the surgery and from frequent blood draws increases your risk of not having enough iron, and getting anemia.

Immunosuppressant (anti-rejection) medicines

If you have a kidney transplant, you are required to take medicines that decrease your immune system, called immunosuppressants. These medicines keep your body from attacking the new kidney. Immunosuppressant medicines can have many side effects, including causing anemia.

The risk of anemia after kidney transplant is higher right after the transplant surgery. This is because the new kidney takes some time before it starts making enough EPO, and because a patient's iron levels are low from losing blood. Over time, the risk for anemia decreases in patients who have had a kidney transplant, as long as their new kidney stays healthy.

Other kinds of anemia

There are several kinds of anemia. Anemia caused by having too little EPO or too little iron in your body are the most common in people with ESRD. Talk to your doctor to learn more.

How will I know if I have anemia?

It can be hard to know whether you have anemia, because it can happen with or without symptoms. Also, many of the symptoms of anemia are not obvious, because they can be caused by other health problems. If you are having symptoms, you should talk to your doctor right away.

Even if you are not having symptoms, you should talk to your doctor about anemia if you have kidney failure. Anemia is very common in patients on dialysis, and also happens in patients with a kidney transplant.

The only way to know if you have anemia is to have a blood test, which checks for the amount of hemoglobin in your blood. Hemoglobin is a part of your red blood cells. Figuring out the amount of hemoglobin in your blood can tell your doctor how many red blood cells you have, and whether you have anemia.

How is anemia treated?

Getting your anemia treated may help you feel better. Depending on the cause of your anemia, your doctor may recommend one or more of the following treatments:

• Erythropoiesis-stimulating agents (ESAs)  — ESAs are injectable medicines that work by sending a signal to your body to make more red blood cells. This replaces the function of the EPO hormone that healthy kidneys normally make.
  • ESAs are given by injection (as a shot).
• Iron supplementation  — Iron supplements will raise the level of iron in your blood when your iron levels are too low.  Depending on how you are treating your kidney failure, you can take your iron supplement in different ways:
  • Iron supplements can be taken orally (as a pill) or given by injection (as a shot). If you are on hemodialysis, you can get the extra iron through the fluid used in your dialysis treatment.
• Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors (HIF-PHIs) — HIF-PHIs are taken orally (by mouth) to help increase red blood cell production and treat anemia in people on dialysis. By enhancing your body's natural response to low oxygen, these medicines can raise red blood cell levels and improve energy. HIF-PHIs also help your body use iron more efficiently, potentially reducing the need for iron supplements. 

Many patients need to take both ESAs and iron supplements to reach a healthy red blood cell count.

• Red blood cell transfusion  — A red blood cell transfusion is a procedure to increase the number of red blood cells in your body by giving you red blood cells from someone else's body through an IV. This can temporarily improve your anemia symptoms.

Why should I treat my anemia?

Although the symptoms of anemia may not always be severe, it may be important to treat anemia if you have it. These are some of the benefits of treating anemia:

• Decrease feelings of weakness and dizziness
• Improve concentration
• Have more energy
• Feel more able to exercise
• Decrease your chances of heart problems
  • Patients with kidney failure are already at higher risk for heart disease. Anemia makes this risk greater.

Doctors and researchers are working on potential new treatments for anemia. New treatments in development are tested in clinical trials. If you're interested in joining a clinical trial to try an investigational new treatment for anemia, visit ClinicalTrials.gov to learn about all available clinical trials for anemia.

Anemia in CKD

Anemia is very common in people with chronic kidney disease (CKD). People with CKD may start to have anemia in the early stages of CKD. Anemia usually gets worse as CKD gets worse. 

Talk with your doctor about anemia

Talk with your doctor or another member of your health care team to find out more about your anemia symptoms and treatment options. Our Talk to Your Doctor Guide can help you get the conversation started.