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Anemia in Chronic Kidney Disease - Types, Symptoms, Diagnosis, and Management

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Anemia occurs when the red blood cell or hemoglobin concentration is low. It is a complication of kidney disease. Read the article to learn more.

Medically reviewed by

Dr. Manzoor Ahmad Parry

Published At November 4, 2022
Reviewed AtApril 18, 2023

Introduction:

Anemia occurs when there are fewer red blood cells present or the hemoglobin concentration of the body is reduced. Hemoglobin is an iron-containing protein that enables the red blood cells to transport oxygen from the lungs to different body organs. In anemia, the red blood cells are very few. As a result, they fail to carry the oxygen from the lungs to the vital organs like the heart, brain, and liver. Anemia is one of the complications of chronic kidney disease.

What Is Chronic Kidney Disease?

The kidneys are important organs of the urinary system and carry out several functions. They work to filter the blood, form urine, and maintain the fluid levels of the body. Chronic kidney disease is the failure of the kidneys to filter the blood as they become permanently damaged. When the blood does not get filtered, the toxins and waste products remain in the body. As a result, a life-threatening condition that is known as blood poisoning or septicemia occurs and affects the other body organs. The term chronic means that kidney damage has not occurred suddenly. Instead, the damage has occurred slowly and over a prolonged period. The patient must undergo treatment for kidney disease at the earliest to avoid complications.

Anemia has been reported to occur in one out of seven individuals suffering from kidney diseases. Diabetic patients suffering from kidney diseases are more likely to develop anemia compared to non-diabetic ones. Anemia occurs in kidney disease due to the following causes:

  1. The kidneys secrete erythropoietin that stimulates the bone marrow to produce red blood cells. If the kidneys are damaged, fewer red blood cells are produced. As a result, there is a disruption in the oxygen supply to the vital organs of the body.

  2. If a person is suffering from chronic kidney disease, the red blood cells do not survive for a long time in the blood. As a result, the red blood cells die and are not replaced with new ones.

  3. People suffering from anemia have a deficiency of nutrients like vitamin B12, folate, and iron. As these substances help in the formation of red blood cells, their scarcity of them causes reduced red blood cell count.

  4. If the patient is on dialysis due to kidney failure, the risk of blood loss increases, resulting in a reduced red blood cell count and anemia.

What Are the Different Types of Anemia in Chronic Kidney Disease?

The different types of anemia that occur in chronic kidney disease are listed below:

  • Iron-Deficiency Anemia - As the name suggests, iron deficiency anemia occurs when the body has iron deficiency due to incomplete iron absorption or loss of iron in the blood. It is commonly seen in women, and the red blood cells fail to form due to iron deficiency.

  • Megaloblastic Anemia - Megaloblastic anemia, also known as vitamin deficiency anemia, occurs when the vitamin B12 and folate levels of the body are low. Megaloblastic anemia occurs commonly in malnourished individuals because they do not have access to a proper diet. It also occurs when vitamin B12 is not absorbed properly from the intestine.

  • Erythropoietin Deficiency Anemia - Erythropoietin is a hormone produced by the kidneys and is responsible for the formation of red blood cells. If the kidneys fail to function, erythropoietin deficiency occurs, resulting in reduced red blood cells and anemia.

What Are the Symptoms of Anemia in Patients With Chronic Kidney Disease?

The symptoms of anemia in patients with chronic kidney disease are listed below:

  1. The patient feels tired throughout the day.

  2. The skin appears pale.

  3. It becomes difficult for the person to carry out daily activities due to continuous body aches and weakness.

  4. Pain in the chest and respiratory difficulties are commonly seen.

  5. The heartbeat becomes irregular.

  6. It is difficult for the patient to concentrate on the work due to headaches and dizziness.

  7. Sometimes, the patient is unable to sleep at night.

How Is Anemia in Chronic Kidney Disease Diagnosed?

The diagnosis of anemia in chronic kidney disease is based on a physical exam, medical history, and blood tests. The diagnostic methods are described below:

  1. Medical History Form - The medical history gives an idea about the symptoms of the condition, the time of their onset, other conditions the patient is suffering from, the medications being taken, the family history, and if the patient has undergone any major surgery in the past.

  2. Physical Examination - The doctor checks the physical signs of anemia, like color change in the skin, infection, or the presence of rashes. The blood pressure and the heart rate of the patient are also checked to rule out heart diseases.

  3. Complete Blood Count (CBC) - This is the most commonly prescribed test if the patient is anemic. The doctor recommends the patient undergo a complete blood count test to check the following:

  • Hemoglobin and Hematocrit Values - Hemoglobin consists of iron and allows the red blood cells to carry oxygen to other body parts. Normally, an adult male should have a hemoglobin concentration of 13 to 16 milligrams per deciliter, and a female should have 11 to 14 milligrams per deciliter of hemoglobin. Hematocrit values indicate the level of red blood cells in the blood. If the hemoglobin and hematocrit values are less than their normal range, anemia can be suspected.

  • The Number of Blood Cells - The complete blood cell count also gives an idea about the number of red blood cells, white blood cells, and blood platelets.

  • Mean Corpuscular Volume - It is a measure of the size of red blood cells. For example, if the patient is suffering from iron deficiency anemia, the red blood cells are small in size.

The doctor might recommend the following additional tests if the complete blood count report (CBC) confirms that the patient is anemic:

  • Reticulocyte Count - Reticulocytes are young or immature red blood cells. This test is done to check if the bone marrow is producing red blood cells at a proper rate or not.

  • Tests to Check Iron Levels - These tests mainly check the levels of ferritin, iron, and transferrin. Ferritin is a protein responsible for storing iron in the cells of the body. Iron is required for the production of hemoglobin, and transferrin carries the iron to different body parts.

How Is Anemia in Chronic Kidney Disease Managed?

It is important to treat the condition that is responsible for causing anemia. For example, if the patient is suffering from iron or vitamin deficiency anemia, treatment needs to be provided to restore the iron and vitamin levels of the body. The other treatments include the following:

  1. Iron Supplements - If the iron levels of the body are low, the doctor usually recommends iron supplements or tablets containing ferrous sulfate. If the patient is on dialysis due to kidney disease, iron is directly injected into the body through the veins. Iron supplements enable the body to use iron and make red blood cells.

  2. Vitamin Supplements - Vitamin B12 and folate capsules are usually recommended by the doctor if the anemia is due to vitamin deficiency. These capsules help restore the vitamin levels of the body because vitamins and iron are essential for red blood cell formation.

  3. Medications - Erythropoiesis-stimulating agents (ESAs) are usually recommended to treat anemia. These medications are injected into the body through the veins, and they stimulate the bone marrow to produce more blood cells. If the patient is on peritoneal dialysis, these medicines are given as shots, and the doctor explains to the patient how to take these shots.

  4. Blood Transfusions - Blood transfusion or blood transfer is a procedure in which the blood from a healthy person is injected into a diseased person. The red blood cell count increases rapidly in this procedure, but there are few side effects. Antibodies might develop in the body at a later stage and destroy the red blood cells. The other side effect includes hemochromatosis, a condition in which the iron levels of the body rise to a dangerous level and cause damage to the internal organs.

  5. Diet - The dietary changes mainly include consuming foods rich in iron and vitamins, like spinach, beans, lentils, pumpkin seeds, broccoli, cabbage, and sprouts. It is important to limit the consumption of salty food items and proteins.

What Are the Complications of Anemia in Chronic Kidney Disease?

The following complications arise if anemia is left untreated for a long time:

  • Heart Diseases - If the patient is suffering from anemia, the hemoglobin concentration of the body is reduced. As a result, the vital organs of the body, like the heart, brain, and liver, do not get sufficient oxygen to carry out their activities. The heart needs to work hard to pump blood to the organs of the body. As a result, the heart becomes enlarged and fails to function.

  • Stokes - Strokes occur when the brain does not receive blood and oxygen. As a result, the cells present in the brain die, and bleeding occurs. Anemic patients are at a higher risk of strokes because they have reduced blood supply due to low hemoglobin levels.

Conclusion:

Anemia is one of the most common complications of kidney disease. Patients who are on dialysis and suffering from diabetes are more likely to develop anemia. If the condition is left untreated for a long time, the patients are likely to suffer from heart diseases and strokes. Anemia is not a life-threatening condition but needs to be managed on time. The patient needs to consult the doctor immediately if any signs and symptoms of anemia are noted along with kidney disease. Chronic kidney failure cannot be reversed, but anemia can definitely be managed.

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Dr. Manzoor Ahmad Parry
Dr. Manzoor Ahmad Parry

Nephrology

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