Anemia in Kidney Disease

Stella mary

Nursing Supervisor, Kauvery Hospital, Hosur, Tamil Nadu

Introduction

Anemia is a common complication of chronic kidney disease (CKD), often referred to as anemia of chronic kidney disease (ACKD) or anemia of renal disease. It occurs because damaged kidneys produce less erythropoietin (EPO), a hormone essential for red blood cell production in the bone marrow. This leads to a lower-than-normal amount of red blood cells or hemoglobin in the blood, resulting in anemia.

Definition – What is Anemia?

Anemia is a condition where the blood has a lower-than-normal number of red blood cells or hemoglobin, the protein in red blood cells that carries oxygen.

Anemia of Kidney Disease

When kidneys are damaged, they produce less erythropoietin (EPO), a hormone that signals the bone marrow to produce red blood cells.

GFR <60 mL/min Normal GFR – 90ml/min

Stages of CKD

StageGFR (mL/min/1.73m2)Description
1≥90Kidney damage with normal or increased GFR
260-89Mildly reduced GFR with kidney damage
3a45-59Mild to moderate reduction in GFR
3b30-44Moderate reduction in GFR
415-29Severe reduction in GFR
5<15 or on dialysisKidney failure

Hemoglobin Level

  • Infancy 6 months–5 years: < 11.0 g/dL
  • Children 5–12 years, and <12.0 g/dL
  • Adult – males HB – 13.0 g/dL

females HB – 12.0 g/dL

Causes in Anemia

  • Relative Erythropoietin (EPO) deficiency
  • Iron deficiency
  • Blood loss (platelet dysfunction, hemodialysis)
  • Shortened red cell life (hemodialysis)
  • Vitamin deficiencies
  • The “Uremic milieu”/Bone marrow suppression
  • Hyperparathyroidism

Conditions in the early stages of chronic kidney disease

Iron Deficiency Anemia in CKD. Blood Loss: Frequent blood draws during dialysis, gastrointestinal bleeding, and blood remaining in dialysis tubing can lead to significant iron loss.

Poor Iron Absorption: CKD can impair the body’s ability to absorb iron from food and supplements.

Malnutrition: CKD patients often have poor appetites and may not consume enough iron-rich foods.

Chronic Inflammation: CKD patients often experience chronic inflammation, which can lead to increased levels of hepcidin, a hormone that blocks iron from being released from storage sites.

Kidney Failure: Damaged kidneys don’t produce enough erythropoietin (EPO), a hormone that stimulates red blood cell production, leading to anemia and iron deficiency.

Symptoms of Anemia in CKD:

  • Fatigue and Weakness: A common symptom, doesn’t receive enough oxygen.
  • Shortness of Breath: Reduced red blood cells mean less oxygen is delivered to the body,
  • Pale Skin: (Pallor) Reduced red blood cells and hemoglobin.
  • Dizziness and Light headache: Caused by reduced oxygen delivery to the brain.
  • Headache: Reduced oxygen levels
  • Chest Pain: Can occur, especially with severe anemia, as the heart strains to pump blood.
  • Body Ache: General discomfort and pain can be associated with an decreased appetite.
  • Swollen Ankles, Feet or Hands: As a result of water retention (edema)
  • Itchy Skin, Dry Skin

Investigation

  • Complete blood count (CBC)
  • Peripheral smear
  • Iron profile
  • Vitamin B12
  • Reticulocyte count (immature red blood cell)
  • free light chain (plasma cell disorder)

Treatment

  • Erythropoiesis-Stimulating Agents (ESAs): Bone marrow to produce more red blood cells.
  • Iron Supplementation: Iron supplementation, either oral or intravenous, helps ensure the body has sufficient iron to produce red blood cells.
  • Other Treatment Options: Red Blood Cell Transfusions: In severe cases of anemia, red blood cell transfusions may be necessary.

Avoid unnecessary transfusions as there is risk of sensitization and cross match turning positive when patient is a transplant candidate.

What is new?

  • Desidustat
  • Lyposomal Iron

Complications of Anemia in CKD

  • Increased Risk of Cardiovascular Disease: Anemia can strain the heart, increasing the risk of heart failure, heart attack, and stroke.
  • Reduced Exercise Tolerance: Anemia can make it difficult to exercise, leading to a reduced quality
  • Increased Risk of Infections
  • Cognitive Impairment: Anemia can affect brain function, memory problems, depression.
  • Bone Weakness
  • Increased Healthcare Costs
  • Poor Quality of Life

Nursing management of anemia CKD

  • Addressing inadequate oxygenation
  • Ensuring proper nutrition
  • Signs of external bleeding
  • Intake and output chart
  • Neurological status
  • Monitor lab values
  • Check stools for occult blood
  • Administer medications as prescribed (Vitamin B12, iron or folate)
  • Educate patient on nutrition (fruits and vegetables to obtain folate and iron)

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