Anemia of Chronic Kidney Disease

anemia chronic kidney diseaseAnemia is a condition in which a person does not have enough healthy red blood cells. Red blood cells serve the role of carrying oxygen throughout the body, thus patients with anemia do not get enough oxygen delivered to their organs. Anemia of chronic disease is a type of anemia that occurs in patients with any chronic (long-term) inflammatory, infectious, or malignant condition, such as Chronic kidney disease (CKD).

Causes of Anemia

There are many types of anemia. All are very different in their causes, which include:

• CKD due to insufficient erythropoietin hormone (EPO)
• Malignancies
• Inflammatory diseases (such as Lupus)
• Infectious diseases (such as HIV/AIDS)
• Blood loss
• Deficiencies in vitamins and minerals (such as lack of iron, vitamin B12, or folic acid)

Symptoms of Anemia

Some patients with Anemia may feel no symptoms at all, and instead discover their Anemia during routine blood testing. Others may present with a variety of symptoms including:

• Fatigue, malaise, reduced energy levels
• Orthostatic symptoms (such as dizziness or headaches)
• Reduced exercise tolerance
• Shortness of breath
• Palpitations
• Cold intolerance
• Cardiovascular symptoms (such as ventricular enlargement)

Testing for Anemia

Anemia can easily be detected with a routine blood test. Additional testing for Anemia may include checking for low iron stores in the body. In certain cases, a bone marrow biopsy may be necessary to further evaluate the condition. During a bone marrow biopsy, a small sample of the patient’s bone marrow is evaluated under a microscope.

Treatment for Anemia:

Some forms of Anemia are easily treatable, while others may create lifelong health problems. If the Anemia is causing no symptoms, it does not necessarily need to be treated. If symptoms are present, the treatment will depend on the cause. Treatment is based on clinical practice guidelines established by The National Kidney Foundation (NKF) Dialysis Outcomes Quality Initiative (DOQI) guidelines and KDIGO guidelines. Treatment may include:

• Erythropoietin Stimulating Agents (ESAs) which help your body make more red blood cells.
• Iron (either oral or intravenous) to aid in the production of red blood cells if an iron deficiency exists. Without sufficient iron stores the ESA treatment may not work as well.
• A blood transfusion in which a patient receives blood that has been donated by somebody else.
• A change in diet that includes eating foods high in iron, vitamin b12, and folic acid.

References:

National Kidney foundation: http://www.kidney.org/atoz/pdf/anemia.pdf

Cleveland Clinic Journal of Medicine: http://ccjm.org/content/73/3/289.full.pdf

KDIGO Practice Guidelines: http://www.kdigo.org/clinical_practice_guidelines

Anemia of chronic kidney disease: Uptodate.com:
http://www.uptodate.com/contents/anemia-of-chronic-kidney-disease-target-hemoglobin-hematocrit-for-patients-treated-with-erythropoietic-agents

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