Anemia is the most common disorder of the blood affecting quarter of people globally. It is defined as a deficiency in the oxygen-carrying protein, hemoglobin, in the blood or in the amount of red blood cell (RBCs). Patients with anemia will experience feeling of tiredness and fatigue – weakness, reduced physical and mental capacity, shortness of breath, headache, dizziness, nausea, and even depression. Anemia can be present temporarily or long term and it can range from mild to severe.
Chronic kidney disease (CKD) is the progressive loss in kidney function. People with CKD often develop anemia. When kidneys are damaged, they do not make enough erythropoietin (EPO), a hormone that controls red blood cell production. As a result, the bone marrow makes fewer red blood cells and lead to the development of anemia. Anemia increases in prevalence as kidney disease progresses, affecting most patients with stage 5 CKD. Anemia in CKD decreases quality of life and cognitive function and increases the risk of cardiovascular morbidity and mortality.
While the diseases that lead to anemia, such as chronic kidney disease, may cause obvious symptoms, the anemia itself can go undetected because the symptoms are minor or nonspecific. There is thus a tendency to dismiss the symptoms as insignificant when in fact the symptoms can serve as alarming signals of disease or pathology. A blood test to measure the hemoglobin level can determine whether you have anemia.
Chronic kidney disease causes no initial symptoms. Lab tests to detect serum or urine creatinine level can detect any developing kidney problems. Anyone at increased risk for chronic kidney disease should be routinely tested. Urine, blood, and imaging tests (X-rays) are used to detect kidney disease, as well as to follow its progress.
The primary therapeutic options for the anemia of CKD include red blood cell transfusions, erythropoiesis-stimulating agents (ESAs), iron and vitamin supplements. ESAs are structurally and biologically similar to naturally occurring form of erythropoietin and include genetically engineered form of EPO. When administered, ESAs stimulate red blood cell production and allow maintenance of hemoglobin at a level that minimizes the need for blood transfusions with their associated complications. ESA treatment has been demonstrated to improving symptoms of anemia such as fatigue and low energy. The use of ESAs has been associated with few adverse effects. Patients should discuss the benefits and risks of ESAs with their health care providers and determine a treatment plan that is right for you.
See your doctor if you suspect you have anemia because anemia can be a sign of serious illnesses.
Brugnara C, Eckardt KU. Hematologic aspects of kidney disease. In: Taal MW, ed. Brenner and Rector’s The Kidney. 9th ed. Philadelphia: Saunders; 2011: 2081–2120 Babitt JL, Lin HY. Mechanisms of anemia in CKD. J. Am. Soc. Nephrol. 2012, 23(10):1631-4.