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Anemia and Chronic Kidney Disease

What is anemia?

Anemia happens when your red blood cells are in short supply. Red blood cells carry oxygen from your lungs to all parts of your body, giving you the energy you need for your daily activities.

What are the symptoms of anemia?

Anemia can cause you to:

  • Look pale
  • Feel tired
  • Have little energy for your daily activities
  • Have a poor appetite
  • Have trouble sleeping
  • Have trouble thinking clearly
  • Feel dizzy or have headaches
  • Have a rapid heartbeat
  • Feel short of breath
  • Feel depressed or "down in the dumps"

Why do people with kidney disease get anemia?

Your kidneys make an important hormone called erythropoietin (EPO). Hormones are chemical messengers that travel to tissues and organs to help you stay healthy. EPO tells your body to make red blood cells. When you have kidney disease, your kidneys cannot make enough EPO. Low EPO levels cause your red blood cell count to drop and anemia to develop.

Most people with kidney disease will develop anemia. Anemia can happen early in the course of kidney disease and grow worse as kidneys fail and can no longer make EPO. Anemia is especially common if you:

  • Have diabetes
  • Are African-American/Black
  • Have moderate or severe loss of kidney function (CKD stage 3 or 4)
  • Have kidney failure (stage 5)
  • Are female

How do I know if I have anemia?

Not everyone with anemia has symptoms. If you have kidney disease, you should have a blood test to measure your hemoglobin level at least once a year to check for anemia. Hemoglobin is the part of red blood cells that carries oxygen throughout your body. If your hemoglobin is too low, it is likely you have anemia. In that case, your healthcare provider will check to find the exact cause of your anemia and plan a treatment that is right for you.

How do you treat anemia?

Your treatment will depend on the exact cause of your anemia.

If your anemia is due to kidney disease, your healthcare provider will treat you with:

  • Drugs called erythropoiesis stimulating agents (ESAs)
    ESAs help your body make red blood cells. Your healthcare provider will give the ESA to you as an injection under the skin.
  • Extra iron
    Your body also needs iron to make red blood cells—especially when you are receiving ESAs. Without enough iron, your ESA treatment will not work as well. Your healthcare provider may give you iron to take as a pill. Another way to receive iron is directly into a vein in your doctor's office or clinic.

For more information please view our full PDF brochures or request a free copy by calling 855.NKF.CARES (855.653.2273) or email

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© 2015 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.

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