CKD and Anemia

Anemia: Common but fatal complication of chronic kidney disease (CKD)

Anemia was first linked to CKD by Richard Bright over 170 years ago. It is a form of normocytic, normochromic, hypoproliferative anemia. Around 60% of CKD non-dialysis dependant patients are anemic with rates of up to 90% in Stage 5 patients. Anemia starts developing when the glomerular filtration rate drops to below 60 mg/ml. The anemia is rare in a patient with a GFR above 80 mg/ml. As the GFR lowers, the anemia worsens.

How does anemia develop in CKD patients?

It is driven by two major factors.

First, patients with CKD produce less erythropoietin (EPO), a hormone produced by the kidneys that stimulate red blood cell production. Second, hepcidin, a hormone that at high levels impairs dietary iron absorption is elevated in patients with CKD.

Management of anemia in CKD?

As we discussed two major factors for developing anemia in CKD, the management of the same is the key here.

Treatment is focused on improving renal function, and increasing red blood cell production. Supplemental iron may help improve iron status; however, it is not the symptom or risk-free and may not treat the condition adequately. The most stable intravenous iron complexes are iron dextran, ferric carboxymaltose, ferumoxytol, and iron isomaltoside. It can be given in higher single doses. Iron isomaltoside is an IV iron that can be administered in doses up to 20 mg per kg body weight, and provides the opportunity for correction of iron deficits in only one visit

ESAs mimic erythropoietin and stimulate red blood cell production in the bone marrow. The most used ESAs are the first-generation erythropoietin-alfa and beta and the second-generation agent Darbepoetin.

Erythropoiesis-stimulating agents with iron supplementation, are the treatment of choice for anemia of chronic renal disease. Find the key recommendations of the most recent anemia guidelines. here.

CKD is at an alarming increase in India, and it has become one of the major causes of mortality. As CKD is a progressive disease managing its complications might help improve the quality of life and exercise tolerance and reduce the need for transfusion and the risk of morbidity and mortality.

Ref: 1. Anemia of Chronic Renal Disease. [Updated 2022 Mar 7]. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2022 Jan-. 2. J Am Soc Nephrol. 2012 Sep 28; 23(10): 1631–1634. 3. Int J Nephrol. 2020; 2020: 7692376. 4. Clin Nephrol. 2019 Apr; 91(4): 246–253. 5. Front Med (Lausanne). 2021; 8: 642296.