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Questions about kidney disease? Risk factors? Signs and symptoms? Are you concerned about yourself, a friend or family member? Ask Dr. Spry.
Did you know that the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKFKDOQI ™) develops guidelines that help your doctor and health care team make important decisions about your medical treatment? The information in this booklet is based on the NKF-KDOQI recommended guidelines for anemia.
There are five stages of chronic kidney disease. They are shown in the table below. Your doctor determines your stage of kidney disease based on the presence of kidney damage and your glomerular filtration rate (GFR), which is a measure of your level of kidney function. Your treatment is based on your stage of kidney disease. Speak to your doctor if you have any questions about your stage of kidney disease or your treatment.
Stages of Kidney Disease
|1||Kidney damage (e.g., protein
in the urine) with normal GFR
|90 or above|
|2||Kidney damage with mild
decrease in GFR
|60 to 89|
|3||Moderate decrease in GFR||30 to 59|
|4||Severe reduction in GFR||15 to 29|
|5||Kidney failure||Less than 15|
|* Your GFR number tells your doctor how much kidney function you have. As chronic kidney disease progresses, your GFR number decreases.|
You may be familiar with the term "anemia" because having anemia is common when you have chronic kidney disease (CKD). Anemia happens when you do not have enough red blood cells. In CKD, kidneys don't make enough of a hormone called erythropoietin (EPO), which your body needs to make red blood cells. When there is not enough EPO, you make fewer red blood cells, and anemia develops. In kidney disease, anemia can happen even before the kidneys fail, and it is very common in people on dialysis.
Although not everyone has the same symptoms, anemia can cause you to:
Your doctor can tell if you have anemia by measuring the hemoglobin (Hb) in your blood. Hemoglobin carries oxygen to all body cells for energy. When you are on dialysis, your hemoglobin should be checked regularly.
"Iron deficiency anemia" means anemia because of too little iron in the body. Iron is important in many ways. It is a mineral needed for overall good health and healthy blood cells. Iron helps your body make hemoglobin, which is found in red blood cells. When there is not enough iron, red blood cells won't have enough hemoglobin to carry oxygen.
Iron is found in many foods, and diet is the major source of iron. Besides not getting enough iron in the diet, other causes of IDA are:
Yes. People on dialysis need extra iron because of:
In fact, when you are on dialysis, you will probably need extra iron because you will be taking another anemia medicine that uses up your iron.
A thorough anemia evaluation will be done so that the right management plan can be made for you. Your hemoglobin should be checked regularly to monitor how well your anemia treatment is working.
Iron levels need to be tested as well because iron helps your body make enough hemoglobin. Having enough iron helps you reach and stay in the recommended hemoglobin target range.
Two important blood tests can tell if you have enough iron. They are called transferrin saturation (TSAT) and ferritin (a form of iron that is stored in the body's tissues).
Iron testing should be done every month until your hemoglobin target is reached. After that, testing every 3 months is recommended if your hemoglobin is stable.
In people on dialysis, anemia is treated with:
Iron is important in treating anemia. Without enough iron, ESAs are wasted and you will not reach your target Hb.
Generally you will begin to feel better and more able to perform your daily activities. Your dialysis team will check your Hb, ferritin, and TSAT levels and perhaps other lab tests regularly. These test values tell how well you are doing. Your dose of ESAs and iron may need to be changed, depending on how you respond to your treatment.
If you are hospitalized, your anemia therapy should continue.
Ask your doctor or your dialysis care team for the results of your Hb, iron and other important tests. You can keep a record of these lab values to help you stay on target. The Dialysis Lab Log can help you do this. To obtain a copy, ask your dialysis care team or call the National Kidney Foundation at 800.622.9010.
IV iron is generally quite safe. Be sure to talk with your doctor or other health care professional if you have any questions and tell them about any medicines that you are allergic to. On rare occasions, some people may have a reaction to IV iron. Reactions may include low blood pressure, nausea, vomiting and/or diarrhea. Severe allergic reactions are rare.
Anemia can cause serious problems with your heart. Treating your anemia is important because:
You will have more energy to do your daily tasks.
The National Kidney Foundation has many booklets to help people on dialysis learn more about kidney disease, its complications like anemia, and its management. Visit www.kidney.org or www.kidney.org/store, or call 800.622.9010.
The National Kidney Foundation (NKF) is dedicated to preventing kidney diseases, improving the health and wellbeing of individuals and families affected by these diseases and increasing the availability of all organs for transplantation.
Through its offices nationwide, the NKF provides early detection screenings and other vital patient and community services. The Foundation conducts extensive public and professional education, advocates for patients through legislative action, promotes organ donation and supports kidney research to identify new treatments.
In 2009 NKF launched a groundbreaking multifaceted collaborative initiative to "End the Wait!" for a kidney transplant in the United States in 10 years by using proven strategies to eliminate barriers to donation and institute best practices across the country.
The NKF relies on individual and corporate donations, foundation and government grants, membership and special events to support its range of programs, services and initiatives.
If you would like more information, please contact us.
©2013 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. No one associated with the National Kidney Foundation will answer medical questions via e-mail. Please consult a physician for specific treatment recommendations.