What causes anemia in CKD? Anemia in people with CKD often has more than one cause. When your kidneys are damaged, they produce less erythropoietin (EPO), a hormone that signals your bone marrow—the spongy tissue inside most of your bones—to make red blood cells.

1. Anemia in chronic
kidney disease
Brincelet M Biju

2. Introduction
1. Kidney damage for more than or equal to 3 months with or without decreased glomerular filtration rate, manifest by either:
✓Pathological abnormalities; or
✓Markers of kidney damage, including abnormalities in the composition of the blood or urine, or abnormalities in imaging tests
2. Glomerular filtration rate <60 mL/min/1.73m^2 for more than or equal to 3 months
❑How is anemia related to chronic kidney disease?
➢Anemia is a common complication of chronic kidney disease.it’s means the patients kidney is damaged and can’t filter blood the
way they should. This damage can cause wastes and fluid to build up in your body.
➢Anemia is less common in early kidney disease, and it often gets worse as kidney disease progresses and more kidney function is
lost.
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3. Stages of chronic kidney disease
one
• Subtitle
Stage GFR( mL/min/1.73 m2) Description
1 >90 Normal or increased glomerular filtration
rate,with other evidence of kidney damage
2 60-89 Slight decrease in GFR, with other evidence of
kidney damage
3a
3b
45-59
30-44
Moderate decrease in glomerularfiltrationrate,
with or without other evidence of kidney
damage
4 15-29 Severe decrease in glomerularfiltrationrate,
with or without other evidence of kidney
damage
<15 Established renal failure

4. What causes anemia in chronic kidney disease.¿
✓Relative erythropoietin (EPO) deficiency
✓Iron deficiency
✓Blood loss
✓Shortened red cell life span
✓Vitamin deficiencies
✓The “uremic milieu” / Bone marrow suppression
✓Inflammation
✓Hyperparathyroidism
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5. Relative erythropoietin deficiency
❑Erythropoietin regulates erythropoiesis
❑Glycosylated polypeptide
❑90% produced in the peritubular interstitial fibroblasts like cells of kidney , 10% in the liver
❑Produced in response to low oxygen tension in the tissues of kidneys
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8. Iron deficiency anemia in chronic kidney disease
o Blood loss from gastrointestinaltract
oIn hemodialysis patients: Repeated blood loss; retention of blood loss in dialysed and
blood lines.
oFrequent blood sampling for IX
oLoss from surgical procedures (vascular access)
oInterference with absorptiondue to meds ( Gastric acid inhibitors, phosphate binders)
oReduced absorption due to inflammation
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9. Blood loss
oRisk of blood loss due to platelet dysfunction
oThe main cause of blood is dialysis, especially
hemodialysis, and the loss results in absolute iron
deficiency.
oHemodialysis patients may lose 3 to 5g of iron per
year.
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10. Shortened red blood cell life span
❑The life span of red cells is reduced by approximately one third in hemodialysis patients
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11. Uremic milieu
•The “uremic milieu” is a term that is overused in attempts to
explain the multiple organ dysfunction of chronic kidney disease.
•For example,”uremic” serum has been shown to inhibit primary
bone marrow cultures of early erythroid cell lines
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12. Diagnosis and evaluation of anemia in chronic kidney
disease
Age or gender group Hb below (g/dl)
Children
6 months to 5 years 11.0
5 to 11 years 11.5
12 to 14 years 12.0
Women > 15 years
(Non-pregnant)
12.0
Men > 15 years 13.0
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14. Differential diagnosis
The followingis a comprehensive list of differential diagnosisthat need to be considered
when diagnosinganemia of chronic renal disease;
✓Alcohol misuse disorder
✓Aplastic anemia
✓Dialysis complications
✓Hypothyroidism
✓Hyperthyroidism
✓Sickle cell anemia
✓Panhypopituitarism
✓Primary and Secondary hyperparathyroidism 14

15. How do we diagnose anemia
in chronic kidney disease
❑Medical history
The health care professional will record the patient’s medical history and may ask about
✓ Patient’s symptoms
✓Current and past medical conditions
✓Prescription and over-the-counter medications the patient take
✓The patient’s family history
❑physical exam
During a physical exam, your health care professional may
✓check the patients blood pressure
✓Check patients heart rate
✓Examine patients body, including checking for changes in skin colour, rashes , or bruising. 15

16. ❑Blood tests
The health care professional will take a blood sample from you and send the sample to a lab to test
✓Number of red blood cells
✓Average size of red blood cells
✓Amount of Hb in the patients blood and in patients red blood cells
✓Number of developing red blood cells, called reticulocytes, in patients blood
Health care professional may also use blood tests to check the amount of iron in blood and stored in the body
✓Ferritin, the protein that stores iron in patients body’s cells
✓Transferrin, a protein in blood that carries iron
Also use the blood to check low levels of folate and vita B12
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17. Key goals in managing anaemia of chronic kidney diseases
❑Increaseexercise capacity
❑Improvecognitive function
❑Regulate and / or prevent left ventricularhypertrophy
❑Preventprogressionof renal disease
❑Reduce risk of hospitalisation
❑Decreasemortality
If your anemia is mild and patient have few symptoms, no need treatment at first. 17

18. Treatment for anemia of chronic kidney disease
❑If patient have enough iron in body, the doctor may prescribe iron supplements,either as a pill or intravenous(IV) infusion.If the patient is
on dialysis,the patient may be given an intravenousiron supplement during dialysis treatment
❑Health professionalmay prescribe erythropoiesisstimulatingagent to treat anemia ,erythropoiesis stimulatingagents send a signal to the
patients bone marrow to make more red blood cells.
✓If the patient is on hemodialysis, he/she may receive IV or subcutaneous erythropoiesisstimulatingagents during the dialysis treatment.If
the patientis on peritoneal dialysis or do not receive dialysis,the doctor may give erythropoiesisstimulatingagents as shots and may teach
the patienthow to do self shots at home.
✓Also the doctor will prescribe iron supplements to help erythropoiesisstimulatingagents work better
✓When treating with erythropoiesis stimulatingagents , avoid hemoglobin >12 grams per deciliter
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19. ❑Select erythropoiesis stimulating agent therapy
✓Epoetin alfa
✓Darbepoetin alfa
❑New drugs have been developed for the treatment of anemia, so called Hypoxia
inducible factor prolyl hydroxylase inhibitors.
❑Monitor hemoglobin, and adjust dose by 25% no more frequently than monthly
to reach and maintain target
❑Also the doctor can use blood transfusions to treat severe anemia in chronic
kidney disease.A blood transfusion can quickly increase the number of red blood
cells in the boys and temporarily relieve the symptoms of anemia.
✓In patients eligible for organ transplantation, we specifically recommend
avoiding, when possible, red cell transfusions to minimise the risk of
allosensitization . 19

20. Summary
❑Anemia in chronic kidney disease arises from diminished erythropoietin
production due to reduced renal function, leadingto a decline in red blood cell
synthesis.
❑Common symptoms include fatigue and weakness.
❑Medical interventionsinvolve erythropoiesis stimulatingagents and iron
supplementation
❑Additionally,non-medical strategies such as dietary adjustments, emphasizing
iron-rich foods, regular exercise, and addressing underlyingcauses like
inflammationor nutritionaldeficiencies, play a pivotal role in the holistic
managementof anemia in chronic kidney disease. 20

21. Conclusion
❑In conclusion, addressing anemia in chronic kidney disease necessitates a multifaceted approach.
❑Medical interventions, including erythropoiesis stimulating agents and iron supplementation, are crucial for managing
the physiological aspects.
❑Simultaneously, non-medical strategies, such as dietary adjustments and lifestyle modifications, contribute to a
comprehensive solution.Recognizing and addressing underlying causes further enhances the effectiveness of treatment.
❑By combining medical and non-medical approaches, we can optimise outcomes and improve the quality of life for
individuals grappling with anemia in the context of chr kidney disease.
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22. Thank you
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Submitted by,
BRINCELET M BIJU