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Anemia and Kidney Disease

Healthy kidneys make a hormone called erythropoietin. Erythropoietin stimulates the bone marrow to make the appropriate number of red blood cells. When the kidneys are not working properly, patients may not have enough erythropoietin or they may be relatively resistant to the effects of erythropoietin.

In this case, the blood will have a reduced number of red blood cells. This is called anemia. Anemia related to reduced kidney function may occur when the kidney function is reduced, and it may occur relatively early in patients who have reduced kidney function because of diabetes.

When significant anemia is present, individuals may have reduced exercise capacity. The heart will work harder to pump the blood and this may cause the heart muscle to thicken. Some patients feel more tired.

If your health care provider discovers anemia, other potential causes should explored. Iron deficiency is very common and patients need robust iron stores to make red blood cells. You may need oral or even intravenous iron. Low iron could mean chronic blood loss.

If iron stores are very low, you should also be evaluated with studies like colonoscopy to find the potential source of bleeding in the gastrointestinal tract. If iron stores are sufficient, then patients with reduced kidney function and moderate to severe anemia can be treated with erythropoietin injections.

Treatment with erythropoietin injections requires careful monitoring with frequent blood work, regular dose titration and regular injections. The best target blood count is not known but the safest strategy appears to target for a mild anemia rather than aiming for normal blood counts.

Page last updated: November 07, 2019