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The Kidney Connection - Anemia and Kidney Disease
EasyLink Access #: 128
 By Allen R. Nissenson, MD, FACP
What Is Anemia?
Anemia is a below-normal level of hemoglobin (Hgb) or hematocrit (Hct). Hgb is the substance in red blood cells (RBCs) that carries oxygen to all parts of your body. Hct is the percentage of RBCs in your blood. The normal laboratory value for Hgb is greater than or equal to 12 g/dL for women and 14 g/dL for men. For Hct, it is greater than or equal to 36% for women and 42% for men. Anemia can be either a temporary or a long-term disease/illness. People with mild anemia may not have any symptoms, or they may have only mild symptoms. Those with severe anemia can feel tired, get short of breath with activity, and have problems doing the things they usually do.1 How Common Is It?
People with kidney disease are at particular risk for anemia. The chance of developing it increases as kidney disease gets worse. A study has shown that anemia affected 28% of people with mild kidney disease and 87% of those with severe kidney disease.2,3 What Causes It?
Damaged kidneys may not produce enough erythropoietin (EPO), a hormone that regulates RBC production. RBCs carry hemoglobin, which delivers oxygen to your bodys cells, tissues, and organs. If there are not enough RBCs, your body does not get the right amount of oxygen. The Importance of Treating Anemia
People who have both kidney disease and anemia have an increased risk of a number of additional serious health problems, including an increased risk of death, stroke, or heart failure.4,5 The chance of an untimely death is even higher in people with anemic kidney disease who also have heart failure and/or diabetes.6 A decreased amount oxygen in your body (the clinical sign of anemia) makes a heart work harder. The result is that the muscles in your hearts left lower chamber may get too thick. This condition is called left ventricular hypertrophy (LVH), which can occur even in people with early kidney disease, and increases the risk of people having a heart attack or dying.7,9 Although there is no guarantee that you will live longer if the anemia is corrected, many studies do show how important it is to treat your anemia. How Do I know if I am Anemic?
Most people do not realize they are anemic until a blood test shows a low Hgb or Hct. Symptoms and signs usually develop when anemia is moderate to severe and can include:
Fatigue;
Weakness;
Pale skin;
Chest pain;
Dizziness;
Irritability;
Numbness or coldness in your hands and feet;
Trouble breathing;
A fast heartbeat; and
Headache. It is important to see your doctor on a regular basis in order to be tested for possible anemia. In people with chronic kidney disease, anemia can occur in the very earliest stages of the disease, and it becomes more severe as the disease progresses.2 How is It Treated?
Since anemia in kidney disease is usually caused by EPO deficiency, improvement of Hgb and Hct levels is often achieved with drugs that stimulate RBC production. If your body does not store enough iron, your doctor will add iron supplements to your treatment plan and correct vitamin deficiencies (low levels of vitamins). Recent studies in patients with kidney disease suggest that complications may occur when anemia is treated too aggressively. You and your doctor can decide what level of Hgb provides you the greatest benefits while minimizing the chances of complications. Your doctor will provide the treatment that is best for you based on what is causing the anemia and the safest approach to treating it. Close communication with your doctor will ensure you will receive the best anemia treatment available. For More Information
National Anemia Action Council (NAAC), http://www.anemia.org. This website offers free information about anemia to patients, healthcare professionals. and the public. See the downloadable patient education sheets at: http://www.anemia.org/patients/educationsheets/. NAAC is a nonprofit organization dedicated to raising the awareness of healthcare professionals and the public regarding the prevalence, symptoms, consequences, and under-treatment of anemia. NAAC is an advisory council made up of 19 leading specialists experienced in treating anemia in chronic disease.
National Kidney Foundation Clinical Practice Guidelines for Managing Anemia in Kidney Disease, http://www.guideline.gov/summary/summary.aspx?doc_id=2784. References
1. National Anemia Action Council. Anemia: A Hidden Epidemic. Accessed at: http://www.anemia.org/professionals/monograph/ on December 12, 2006.
2. Kausz, AT, Khan, SS, and Abichandani, R, et al. Management of patients with chronic renal insufficiency in the Northeastern United States. Journal of the American Society of Nephrology 2001;12:1501-1507.
3. Kausz, AT, Steinbert, EP, Nissenson, AR, and Pereira, BJ. Prevalence and Management of Anemia Among Patients with Chronic Kidney Disease in a Health maintenance organization. Disease Management and Health Outcomes 2002;10:505-513.
4. Foley, RN, Parfrey, PS, Harnett, JD, Kent, GM, Murray. DC, and Barre, PE. The impact of anemia on cardiomyopathy, morbidity, and mortality in end-stage renal disease. American Journal of Kidney Diseases 1996;28:53-61.
5. Abramson, JL, Jurkovitz, CT, Vaccarino, V, Weintraub, WS, and McClellan W. Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study. Kidney International 2003;64:610-5.
6. Collins, A. American Society of Nephrology Symposium Presentation, December 2002.
7. Levin, A, Thompson. CR, and Ethier, J, et al. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. American Journal of Kidney Diseases 1999;34:125-134.
8. Casale, PN, and Devereux, et al. Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Annals of Internal Medicine 1986;105:173-178.
9. Silberberg, JS, Barre, PE, Prichard, SS, and Sniderman, AD. Impact of left ventricular hypertrophy on survival in end-stage renal disease. Kidney International 1989;36:286-90. About the Author
Allen R. Nissenson, MD, FACP, is President of the National Anemia Action Council and Professor of Medicine and Director of the Dialysis Program at the David Geffen School of Medicine at the University of California, Los Angeles. He is the author of two dialysis textbooks and was the founding Editor-in-Chief of Advances in Renal Replacement Therapy. Dr. Nissenson is currently Editor-in-Chief of Hemodialysis International and is credited with over 340 scientific publications. Last Updated May 2007
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