Article title: Anemia in Kidney Disease and Dialysis: NIDDK
Conditions: Anemia, kidney disease, kidney dialysis, ESRD
Source: NIDDK
NIDDK Home : Health Information : Kidney Diseases : Kidney Failure | |||||||||
IntroductionIf your blood is low in red blood cells, you have anemia. Red blood cells carry oxygen (O2) to tissues and organs throughout your body and enable them to use the energy from food. Without oxygen, these tissues and organs--particularly the heart and brain--may not do their jobs as well as they should. For this reason, if you have anemia, you may tire easily and look pale. Anemia may also contribute to heart problems.Anemia is common in people with kidney disease. Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs. Diseased kidneys, however, often don't make enough EPO. As a result, the bone marrow makes fewer red blood cells. Other common causes of anemia include loss of blood from hemodialysis and low levels of iron and folic acid. These nutrients from food help young red blood cells make hemoglobin (Hgb), their main oxygen-carrying protein. [Top] Laboratory TestsA complete blood count (CBC), a laboratory test performed on a sample of your blood, includes a determination of your hematocrit (Hct), the percentage of the blood that consists of red blood cells. The CBC also measures the amount of Hgb in your blood. The range of normal Hct and Hgb in women who menstruate is slightly lower than for healthy men or healthy postmenopausal women. The Hgb is usually about one-third the value of the Hct.[Top] When Anemia BeginsAnemia may begin to develop in the early stages of kidney disease, when you still have 20 percent to 50 percent of your normal kidney function. This partial loss of kidney function is often called chronic renal insufficiency. Anemia tends to worsen as kidney disease progresses. End-stage kidney failure, the point at which dialysis or kidney transplantation becomes necessary, doesn't occur until you have only about 10 percent of your kidney function remaining. Nearly everyone with end-stage kidney failure has anemia.[Top] DiagnosisIf you have lost at least half of normal kidney function (serum creatinine greater than 2 mg/dL) and have a low Hct, the most likely cause of anemia is decreased EPO production. The National Kidney Foundation's Dialysis Outcomes Quality Initiative (DOQI) recommends that doctors begin a detailed evaluation of anemia in men and postmenopausal women on dialysis when the Hct value falls below 37 percent. For women of childbearing age, evaluation should begin when the Hct falls below 33 percent. The evaluation will include tests for iron deficiency and blood loss in the stool to be certain there are no other reasons for the anemia. | |||||||||
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[Top]TreatmentEPOIf no other cause for EPO deficiency is found, it can be treated with a genetically engineered form of the hormone, which is usually injected under the skin two or three times a week. Hemodialysis patients who can't tolerate EPO shots may receive the hormone intravenously during treatment, but this method requires a larger, more expensive dose and may not be as effective. DOQI recommends that patients treated with EPO therapy should achieve a target Hgb of 11 to 12 g/dL. Iron Many people with kidney disease need both EPO and iron supplements to raise their Hct to a satisfactory level. If your iron levels are too low, then EPO won't help and you'll continue to experience the effects of anemia. You may be able to take an iron pill, but many studies show that iron pills don't work as well in people with kidney failure as iron given intravenously. Iron is injected directly into an arm or into the tube that returns blood to your body during hemodialysis. A nurse or doctor will give you a test dose because a very small number of people (less than 1 percent) have a bad reaction to iron injections. If you begin to wheeze or have trouble breathing, your health care provider can administer epinephrine or corticosteroids to counter the reaction. Even though the risk is small, you'll be asked to sign a form stating that you understand the possible reaction and that you agree to have the treatment. Talk with your health care provider if you have any questions. In addition to measuring your Hct and Hgb, your tests will also include two measurements to show whether you have enough iron.
Other Causes of AnemiaIn addition to EPO and iron, a few people may also need vitamin B12 and folic acid supplements.If EPO, iron, vitamin B12, and folic acid all fail, your doctor should look for other causes such as sickle cell disease or an inflammatory problem. At one time, aluminum poisoning contributed to anemia in people with kidney failure because many phosphate binders used for treating bone disease caused by kidney failure were antacids that contained aluminum. But aluminum-free alternatives are now widely available. Be sure your phosphate binder and your other drugs are free of aluminum. Anemia keeps many people with kidney disease from feeling their best. But EPO treatments help most patients raise their Hgb, feel better, live longer, and have more energy. [Top] Hope Through ResearchThe National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), through its Division of Kidney, Urologic, and Hematologic Diseases, supports several programs and studies devoted to improving treatment for patients with progressive kidney disease and end-stage kidney failure (sometimes called end-stage renal disease, or ESRD), including patients on hemodialysis:
For More InformationFor more information, contact the following organizations:American Association of Kidney Patients 100 South Ashley Drive Suite 280 Tampa, FL 33602 Phone: 1-800-749-2257 or (813) 223-7099 Fax: (813) 223-0001 Email: AAKPnat@aol.com Internet: http://www.aakp.org/ American Kidney Fund 6110 Executive Boulevard Suite 1010 Rockville, MD 20852 Phone: 1-800-638-8299 Fax: (301) 881-0898 Email: mailto:helpline@akfinc.org Internet: http://www.akfinc.org/ National Kidney Foundation 30 East 33rd Street New York, NY 10016 Phone: 1-800-622-9010 Fax: (212) 889-2210 Email: info@kidney.org Internet: http://www.kidney.org/ [Top] About the Kidney Failure SeriesThe NIDDK Kidney Failure Series includes six booklets and seven fact sheets that can help you learn more about treatment methods for kidney failure, complications of dialysis, financial help for the treatment of kidney failure, and eating right on hemodialysis. For free single printed copies of this series, please contact the National Kidney and Urologic Diseases Information Clearinghouse.[Top] National Kidney and Urologic Diseases Information Clearinghouse3 Information WayThe National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1987, the clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases. Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet was reviewed by Dr. John C. Stivelman, Emory University School of Medicine. This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired. [Top] NIH Publication No. 01-4619 April 2001 Posted: May 2001 |
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