Anemia is a condition in which the body has fewer red blood cells than normal. Red blood cells carry oxygen to tissues and organs throughout the body and enable them to use energy from food. With anemia, red blood cells carry less oxygen to tissues and organs—particularly the heart and brain—and those tissues and organs may not function as well as they should. How is anemia related to chronic kidney disease? Anemia commonly occurs in people with chronic kidney disease (CKD)—the permanent, partial loss of kidney function. Anemia might begin to develop in the early stages of CKD, when someone has 20 to 50 percent of normal kidney function. Anemia tends to worsen as CKD progresses. Most people who have total loss of kidney function, or kidney failure, have anemia.1 A person has kidney failure when he or she needs a kidney transplant or dialysis in order to live. The two forms of dialysis include hemodialysis and peritoneal dialysis. Hemodialysis uses a machine to circulate a person’s blood through a filter outside the body. Peritoneal dialysis uses the lining of the abdomen to filter blood inside the body. What are the kidneys and what do they do? The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine. Healthy kidneys produce a hormone called erythropoietin (EPO). A hormone is a chemical produced by the body and released into the blood to help trigger or regulate particular body functions. EPO prompts the bone marrow to make red blood cells, which then carry oxygen throughout the body. What causes anemia in chronic kidney disease? When kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone marrow makes fewer red blood cells, causing anemia. When blood has fewer red blood cells, it deprives the body of the oxygen it needs. If treatments for kidney-related anemia do not help, the health care provider will look for other causes of anemia, including •other problems with bone marrow •inflammatory problems—such as arthritis, lupus, or inflammatory bowel disease—in which the body’s immune system attacks the body’s own cells and organs •chronic infections such as diabetic ulcers •malnutrition Healthy kidneys produce a hormone called EPO. EPO prompts the bone marrow to make red blood cells, which then carry oxygen throughout the body. When the kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone marrow makes fewer red blood cells, causing anemia. What are the signs and symptoms of anemia in someone with chronic kidney disease? The signs and symptoms of anemia in someone with CKD may include •weakness •fatigue, or feeling tired •headaches •problems with concentration •paleness •dizziness •difficulty breathing or shortness of breath •chest pain To diagnose anemia, a health care provider may order a complete blood count, which measures the type and number of blood cells in the body. A blood test involves drawing a patient’s blood at a health care provider’s office or a commercial facility. A health care provider will carefully monitor the amount of hemoglobin in the patient’s blood, one of the measurements in a complete blood count. If blood tests indicate kidney disease as the most likely cause of anemia, treatment can include injections of a genetically engineered form of EPO. A health care provider, often a nurse, injects the patient with EPO subcutaneously, or under the skin, as needed. Some patients learn how to inject the EPO themselves. Patients on hemodialysis may receive EPO intravenously during hemodialysis. Studies have shown the use of EPO increases the chance of cardiovascular events, such as heart attack and stroke, in people with CKD. The health care provider will carefully review the medical history of the patient and determine if EPO is the best treatment for the patient’s anemia. Experts recommend using the lowest dose of EPO that will reduce the need for red blood cell transfusions. Additionally, health care providers should consider the use of EPO only when a patient’s hemoglobin level is below 10 g/dL. Health care providers should not use EPO to maintain a patient’s hemoglobin level above 11.5 g/dL.2 Patients who receive EPO should have regular blood tests to monitor their hemoglobin so the health care provider can adjust the EPO dose when the level is too high or too low.2 Health care providers should discuss the benefits and risks of EPO with their patients. Red Blood Cell Transfusions If a patient’s hemoglobin falls too low, a health care provider may prescribe a red blood cell transfusion. Transfusing red blood cells into the patient’s vein raises the percentage of the patient’s blood that consists of red blood cells, increasing the amount of oxygen available to the body. Eating, Diet, and Nutrition A health care provider may advise people with kidney disease who have anemia caused by iron, vitamin B12, or folic acid deficiencies to include sources of these nutrients in their diets. Some of these foods are high in sodium or phosphorus, which people with CKD should limit in their diet. Before making any dietary changes, people with CKD should talk with their health care provider or with a dietitian who specializes in helping people with kidney disease. A dietitian can help a person plan healthy meals. Recommended Daily Value 18 mg 6 mcg 400 mcg 100 percent fortified breakfast cereal ¾ cup (1 oz) 18 mg 6 mcg 394 mcg beans, baked 1 cup (8 oz) 8 mg 0 mcg 37 mcg beef, ground 3 oz 2 mg 2 mcg 8 mcg beef liver 3 oz 5 mg 67 mcg 211 mcg clams, fried 4 oz 3 mg 1 mcg 66 mcg spinach, boiled 1 cup (3 oz) 2 mg 0 mcg 115 mcg spinach, fresh 1 cup (1 oz) 1 mg 0 mcg 58 mcg trout 3 oz 0 mg 5 mcg 16 mcg tuna, canned 3 oz 1 mg 1 mcg 2 mcg .
Posted on: Sat, 24 Jan 2015 22:04:04 +0000
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