Managing Anemia and Symptoms of Fatigue Patients with chronic kidney disease (CKD) are prone to develop anemia. Anemia is a condition affecting your blood that can make you feel tired or weak. This article explains how anemia can develop as a result of CKD, the symptoms of anemia and how anemia is diagnosed. It also provides advice about how to properly manage anemia with your health care team.
The Kidneys and Blood
The kidneys fill an extremely important role of keeping your blood clear of waste products that develop as part of normal bodily function. In addition to filtering toxins from your blood, they also help assure there are enough red blood cells in the blood. Red blood cells are important because they collect oxygen from the lungs and distribute it to all parts of the body through the circulatory system.
Normally, the kidneys produce a hormone called erythropoietin which triggers the bone marrow to make new red blood cells when there are not enough in the blood. In CKD patients, however, the poorly functioning kidneys may not be able to produce enough erythropoietin, leading to a shortage of red blood cells. Without enough red blood cells and their oxygen-carrying power, anemia can develop making you feel tired, weak or even dizzy.
Anemia Symptoms & Detection
Anemia and its symptoms usually develop slowly as kidney function decreases and they gradually become worse at making erythropoietin. While initial symptoms may consist of fatigue, weakness and dizziness, as anemia worsens it may result in the development of pale skin, brittle nails, chest pain, coldness in your hands or feet, or an irregular heartbeat.
Some people with anemia may also have a desire to eat ice, experience sexual dysfunction, or have trouble concentrating or performing mental tasks. Any symptoms which you believe may be caused by anemia should be reported to your health care professional.
“Although symptoms of fatigue can be an early sign of anemia, a simple blood test is required to make the diagnosis,” explained Dr. Bradley Warady, a pediatric nephrologist and board member of the National Anemia Action Council (NAAC). “The only way to tell if you have anemia is by measuring your hemoglobin level.”
Hemoglobin is a protein contained in red blood cells and is the component of the cells that carries oxygen. Your doctor can easily measure your hemoglobin level.
Along with checking your hemoglobin level, it is also important to measure the stored iron in your body since iron is required to make red blood cells. An iron work-up provides results for total iron binding capacity, transferring saturation and ferritin level – tests that can help your doctor determine how well your body is acquiring, storing and utilizing iron to make healthy red blood cells. An evaluation of iron is important because even if your hemoglobin level is high enough that you are not considered anemic, an unhealthy iron level could mean it is just a matter of time before you develop anemia.
Anemia at Different CKD Stages
Anemia is a common complication of CKD, affecting 28 percent of early-stage patients and over 85 percent of patients in the later stages of the disease (1, 2). Although anemia often results from the kidney’s reduced ability to make erythropoietin, it can also be caused by not eating foods that provide enough iron, vitamin B12 or folic acid (folate). Heavy menstrual bleeding, bleeding ulcers or a chronic condition like inflammatory bowel disease (IBD), rheumatoid arthritis or cancer can also cause patients to be more likely to develop anemia.
If you are a CKD patient in stages 1 or 2 and are found to be anemic, it is very important for your doctor to determine the exact cause of anemia and not to assume it is a result of your kidney disorder. Once the cause of anemia can be determined, your doctor can recommend a suitable treatment. If you are a CKD patient in stages 3, 4 or 5, it is very important for you and your health care team to be closely monitoring your hemoglobin level and your iron status.
Effectively Treating Anemia
The successful treatment of anemia regularly results in patients feeling better with reduced symptoms of fatigue. One important step includes eating an iron-rich diet with meat, leafy green vegetables and iron-fortified grains. In addition, your doctor may recommend you take an over-the-counter oral iron supplement or that you receive intravenous (IV) iron to raise your iron levels if they are too low.
Even with an adequate amount of iron, the progression of CKD may lead to the need for many patients to receive drugs called erythropoiesisstimulating agents (ESAs) to treat their anemia. These drugs act like the body’s natural erythropoietin and are administered to boost the production of red blood cells. Although patients are considered anemic if their hemoglobin falls below the normal range for men and women - 13 g/dL and 12 g/dL respectively, ESA treatment often begins only once the hemoglobin level falls below 10 g/dL. Symptoms of anemia most often occur below this level.
If you are receiving an ESA, it remains important to keep your iron levels high so your body can handle the increased red blood cell production. Iron injections, often administered through an IV, are typically given to patients receiving ESA treatment. Both of these therapies can be given during regular doctor’s visits or dialysis treatments. Once your hemoglobin levels begin to increase, your doctor may need to adjust ESA and iron dosing to keep your hemoglobin within the recommended range of 11-12 g/dL.
Communicating with your Health Care Team
For CKD patients, monitoring anemia is an essential part of optimizing their health. It takes diligence to track hemoglobin levels and to communicate symptoms related to anemia. Yet, Dr. Warady emphasizes that, “Just by understanding the importance of managing their health and working closely with their health care team, patients will have a far better chance of effectively treating anemia and its symptoms.”
The National Anemia Action Council (NAAC) is a nonprofit organization providing expert, in-depth anemia information to patients and health care professionals. Visit www.anema.org for additional handouts, articles and newsletters addressing anemia and chronic kidney disease (CKD).
References
1. Kausz AT, et al. J Am Soc Nephrol. 2001;12:1501-1507.
2. Kausz AT, et al. Dis Manage Health Outcomes. 2002;10:505-513.
This article originally appeared in the September 2009 issue of Kidney Beginnings: The Magazine.
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