Patients with Chronic Kidney Diseases most often have anemia, the condition where a person’s red blood cells are depleted. While those with CKD do not produce enough erythropoietin, patients on dialysis are more likely to get anemia which will worsen as the kidneys stop making EPO.
The good news is that this condition can be treated and managed.
The condition is more common with those who have diabetes, are female, African-America, have moderate or severe loss of kidney function (either stage 3 or 4) and failure (stage 5).
Patients with anemia may or may not exhibit symptoms so the best way to find out is to have a blood test that measures hemoglobin level at least once a year. The normal range for hemoglobin level for women is 12.0 while for men it is 13.5 If a patient falls below this range then he /she has anemia. In which case, the doctor has to determine the cause to develop a customized treatment plan.
Treatment can be done in two ways: through drugs called erythropoiesis-stimulating agents that help the body make red blood cells and through extra iron. ESA will be prescribed by the doctor to restore the hemoglobin to normal level. Short-acting ESAs are more effective when administered under the skin (subcutaneous); while long-acting ones are just as effective no matter how they are given to the patient.
Meanwhile, your body will use iron faster when on an ESA medication, especially when you’re on hemodialysis because extra amounts are needed to make the treatments effective. Without which, the treatments are wasted. Iron levels are tested through the Transferin Saturation (TSAT) which should be 20 %; and Ferritin which should be greater than 200 ng/ml on hemodialysis and greater than 100 ng/ml when on peritoneal dialysis. This should be tested until the anemia is controlled. Iron is most effective when administered through IV which can be injected in the blood tubes during hemodialysis. Those on peritoneal dialysis may be given the supplement by mouth or through IV.
Foods rich in iron, vitamin B12 and folic acid are helpful to patients with anemia. Your dietician can help with meal plans. Treatment may be a lifetime deal even after a successful kidney transplants since the new organ may not produce all the EPO needed. Immunosuppressive drugs needed after transplant may affect EPO production.
Untreated anemia causes serious health problems that can lead to heart disease called left ventricular hypertrophy (LVH). Those with CKD eventually develop LVH before reaching stage 5 of the disease and die from this.