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Anemia of Chronic Kidney Disease

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What is anemia of chronic kidney disease?

Anemia of chronic kidney disease means that kidney disease has caused your anemia. Your doctor will have ruled out other causes of anemia.

Anemia means that you do not have enough red blood cells. Red blood cells carry oxygen from your lungs to your body's tissues. If your tissues and organs do not get enough oxygen, they cannot work as well as they should.

Anemia is common in people who have chronic kidney disease. It can make you feel weak and tired. With treatment, you may feel better and enjoy life more.

What causes it?

Red blood cells are made by the bone marrow. To get the marrow to make red blood cells, the kidneys make a hormone called erythropoietin, or EPO. When the kidneys are damaged, they may not make enough EPO. Without enough EPO, the bone marrow does not make enough red blood cells, and you have anemia.

In most cases, the more damaged the kidneys are, the more severe the anemia is. In general, people whose kidneys are not working at the normal level may get anemia.

What are the symptoms?

Anemia may develop early in kidney disease, but you may not have symptoms until the late stages of the disease.

As anemia gets worse, you may:

  • Feel weak and tire out more easily.
  • Feel dizzy.
  • Be irritable.
  • Have headaches.
  • Look very pale.
  • Feel short of breath.
  • Have trouble concentrating.

How is it diagnosed?

Your doctor can decide if you have anemia of chronic kidney disease when you have both anemia and chronic kidney disease and there is no other reason for anemia.

Your doctor will do blood tests, including a complete blood count (CBC), to learn about your red blood cells and possible reasons for your anemia.

How is anemia of chronic kidney disease treated?

The two main treatments for anemia in kidney disease are iron and erythropoietin-stimulating agent (ESA).

  • To build the iron levels in your body, you may need to take iron pills or get iron through an injection into a vein (IV).
  • If tests suggest that your kidneys are not making enough erythropoietin (EPO), you may need a man-made form of this hormone called an ESA. This medicine is most often given as a shot under the skin (subcutaneous).

Both treatments can be given through an IV during dialysis.

Other possible treatments include:

  • Diet changes. Ask your doctor if eating more foods high in iron, folic acid, and vitamin B12 could help your anemia. But don't make changes to your diet until you talk to your doctor first.
  • In rare cases, a blood transfusion. A blood transfusion gives you new blood or parts of blood you need, such as red blood cells. But this is done only if your anemia is severe.


Current as of: March 1, 2023

Author: Healthwise Staff
Medical Review:
Martin J. Gabica MD - Family Medicine
Kathleen Romito MD - Family Medicine
Mitchell H. Rosner MD - Nephrology