Usually anemia begins in the early stages of chronic kidney disease and gets worse as kidney function decreases. Anemia is a condition where your body is not making enough red blood cells and causes a considerable amount of weakness and fatigue, leading people to live a a poor quality of life. To help people with chronic kidney disease and anemia have more energy, anemia management is part of their kidney disease treatment.

Managing anemia with iron

Iron is a mineral in the body that is needed to make healthy red blood cells. Without iron the body cannot produce enough red blood cells, causing iron deficiency anemia. Iron deficiency can be due to a lack of iron-rich foods in the diet, such as red meat, green leafy vegetables and eggs, as well as infection, inflammation or blood loss through hemodialysis, menstruation or other causes.

To treat anemia, iron levels must be known. The doctor will likely order blood tests to help determine the cause of iron deficiency.

Other ways to manage anemia

Nearly everyone with end stage renal disease (ESRD) has anemia. Before the 1990s, anemia was treated with blood transfusions. Some of the risks of transfusions included allergic reactions, iron overload and infections. Now there are a number of drug options to help with anemia. These drugs are called erythropoiesis-stimulating agents (ESAs) because they stimulate the formation and production of red blood cells.

Recombinant human erythropoietin (rHuEPO) is a protein created in a laboratory that has the same effects as the erythropoietin produced in the body. rHuEPO is given to patients to increase their red blood cell production. People with CKD who are not on dialysis go to their doctor’s office for injections. Those doing in-center hemodialysis can get rHuEPO intravenously (IV) while they are at dialysis treatments, if it’s prescribed by their doctor.

Once the doctor reviews the patient’s blood work and takes into consideration the patient’s health needs, he or she may write a prescription for an ESA, if needed. Patients will be monitored by their doctors who will decide the best dose based on their individual medical situation.

If a patient’s hemoglobin does not go up after beginning treatment with an erythropoiesis-stimulating agent, the doctor will recheck iron. Even though there is now a higher level of erythropoietin in the body, there needs to be enough iron for red blood cell production to occur. Vitamin B-12 and folic acid levels must also be in a normal range for healthy red blood cell production to occur.

Talk to your doctor about anemia management

Managing anemia in people with kidney disease helps prevent fatigue and other symptoms, improves heart health and decreases hospitalizations. Talk to your doctor or members of your health care team to learn more about anemia management.