Associates of Kentuckiana, PSC provides care for all aspects of the prevention and
treatment of kidney disease. Anemia is often a side effect of kidney
diseases and can occur
as early as Stage 3. Anemia is the condition
defined as insufficient red blood cells. Red blood cells carry oxygen from your lungs to
all parts of your body, giving you the energy you need for your
daily activities. Anemia can cause you to:
Have little energy for your daily activities
Have a poor appetite
Have trouble sleeping
Have trouble thinking clearly
Feel dizzy or have headaches
Have a rapid heartbeat
Feel short of breath
Feel depressed or “down in the dumps”
FAQ about Anemia
Why do people on
dialysis get anemia?
Your kidneys make an important
hormone called erythropoietin (EPO). Hormones are secretions that your
body makes to help your body work and keep you healthy. EPO
tells your body to make red blood cells. When you have kidney disease,
your kidneys cannot make enough EPO. This
causes your red blood cell count to drop and anemia to develop.
Are all people
on dialysis at risk for anemia?
Most people with kidney disease
will develop anemia. Anemia can happen early in the course of kidney
disease and grow worse as kidneys lose their ability to work well and
make EPO. Anemia is especially common if you:
How is anemia treated?
If your anemia is due to kidney
failure, you will be treated with:
Drugs called erythropoiesis-stimulating
agents (ESAs). ESAs act like the natural hormone EPO, which helps your
to make red blood cells.
Extra iron. Your body also needs
iron to make red blood cells—especially if you are receiving ESAs.
Without enough iron, your ESA treatment will not work.
What is the goal of
The goal of anemia treatment is
to increase your hemoglobin level to at least 11, which is considered
to be the lowest level of hemoglobin you need to feel well. As you get
closer to or pass this level, you should notice that you have more
energy and feel less tired. [TOP]
is ESA given?
ESAs can be given to you in the
As an injection under the skin.
This is called a subcutaneous injection (SC).
Injected through the blood tubes
during dialysis. This is called an intravenous injection (IV).
You and your doctor will decide which method is best for you.
How much ESA will I need? Your doctor will prescribe enough ESA
to increase your hemoglobin gradually to the recommended level. How
much ESA you need and how often you receive it depends on:
- Your current hemoglobin level
- How well you respond to treatment with ESA
- The type of ESA you receive
Two different types of ESAs are available—short-acting ESAs and
long-lasting ESAs. Short-acting ESAs are more effective when given
subcutaneously (as an injection under the skin) rather than by IV
(through the blood tubes during dialysis). Examples of short-acting
ESAs are epoetin alfa and epoetin beta. Long-lasting ESAs are equally
regardless of how they are given. Darbepoetin is an example of a long
lasting ESA. [TOP]
How is my iron level tested?
Two important tests can tell if
you have enough iron. They are called transferrin saturation (TSAT)
and ferritin. To make sure you have enough iron to reach the
- Greater than 200 ng/mL (when
are on hemodialysis)
- Greater than 100 ng/mL (when you
are on peritoneal dialysis)
How will iron be given to me?
Iron is most effective when given
by IV. IV iron can be injected into the blood tubes during
hemodialysis. For patients receiving peritoneal dialysis, iron can be
given either by IV or as a pill by mouth. [TOP]
Can diet help my anemia?
Eating foods that are high in
iron, vitamin B12 and folic acid may be helpful for some patients with
anemia. Your dietitian can help you plan meals to include foods that
are good sources of these vitamins and minerals. Check with your
doctor before making any changes in your diet. [TOP]
How long will I need
You will probably need treatment
for life—even if you have a successful kidney transplant.
Unfortunately, even a new kidney may not be able to make all the EPO
you need to make enough red blood cells. One reason this happens is
because the immunosuppressive drugs needed after getting a new kidney
can affect EPO production. So medication for anemia may still be
needed even after a successful transplant. [TOP]
What if my anemia isn’t
If untreated, anemia can cause
serious problems. Anemia can make your other health problems worse. A
low supply of red blood cells in your body (anemia) can make your
heart work harder. This can lead to a type of heart disease called
left ventricular hypertrophy (LVH). Unfortunately, many people with
kidney disease develop LVH long before they reach kidney failure, and
some will even die from it. Early treatment of anemia may help prevent
this problem and other serious complications from happening. [TOP]