Friday, October 07, 2022

What is renal anemia, why it occurs and how it is treated

In Spain, between 10 and 15% of the population suffers from some degree of chronic kidney disease (CKD), a chronic disease that progressively worsens renal function and has many comorbidities. One of them is anemia, one of the most frequent complications of patients with CKD, which can affect up to 90% of them in advanced stages of the disease and patients on dialysis.

Treating it apart from the disease is important, as anemia in people with CKD is associated with a significant decrease in quality of life in patients who already live with serious health problems.

Why do patients with chronic kidney disease have anemia?

Anemia is a very common complication in patients with CKD, as the production of red blood cells It is related to the proper functioning of the kidneys. In addition to filtering the blood, the kidneys produce a hormone called erythropoietin, or EPO. When, due to kidney failure, this hormone is decreased, the bone marrow does not produce enough red blood cells and causes anemia.

Even if the patient with CKD has anemia, before starting treatment, it should be ruled out that it is due to other causes, as the most frequent cause of anemia – especially in patients on antiplatelet or anticoagulant treatment – or other deficiency anemias (vitamin B12 or folic acid) is iron deficiency anemia, and in renal anemia patients are not necessarily iron deficient. Even so, it is normal for both anemias to coexist in patients with CKD.

kidneys, kidney

Renal anemia can appear in stage 2 of the disease, but it is more common in stages from 4 onwards and in dialysis patients it reaches 90%.

The symptoms of renal anemia are the same as those of iron deficiency anemia: tiredness, fatigue, weakness, irritability, headache, pallor… and in more severe cases, even cardiovascular disorders. It is diagnosed through a blood test.

How is renal anemia treated?

To treat and correct renal anemia, substances in which there is a deficit must be administered externally, either iron or the hormone erythropoietin (EPO).

• Oral administration of iron. The first treatment option to try to correct anemia in patients with CKD is to prescribe oral iron, about 200 mg/day of elemental iron. Sometimes iron is not well tolerated as it can cause gastrointestinal discomfort.

• Intravenous iron. If after three months the anemia is not corrected despite oral treatment or if the patient does not tolerate it or if there is malabsorption, iron can be given intravenously. The most frequent complication is allergic reactions.

• Treatment with AEE-EPO. If anemia continues to exist and EPO hormone deficiency is confirmed, treatment can be started with ESA-EPO, an inpatient treatment. This treatment is very common in dialysis patients and, before administering it, the patient must have adequate iron levels. In fact, with ESA-EPO treatment, iron needs increase, so it must be supplemented with external iron supplementation, either orally or intravenously. In dialysis patients, it is very common for iron to be administered intravenously.

•Although not common, sometimes these types of patients with anemia grave or who do not respond adequately to necessary treatments regular blood transfusions.

Image of a dialysis treatment.

Patients with renal anemia should be monitored very regularly, in addition to checking the levels of red blood cells, to monitor that other adverse effects resulting from the treatment do not occur, as they increase the chances of suffering hypertension, stroke or access thrombosis. vascular.

It is common for patients with renal anemia to have to take other supplements that help control anemia, such as vitamin B12 or folic acid, and to have to closely monitor their diet to avoid further deficiencies.

The National Institute of Renal Anemia (INAR) is born

With the objective of bringing together the health professionals involved, improving the approach to the disease and raising awareness about anemia associated with Chronic Kidney Disease (CKD), the company GSK launched the National Institute of Renal Anemia (INAR). In it, health professionals such as nephrologists, cardiologists, internal medicine physicians, geriatricians and primary care physicians, among others, will be able to share ideas and activities to improve the quality of life of patients with renal anemia. As stated by Dr. Aleix Cases, Senior Consultant of the Nephrology Service of the Hospital Clínic de Barcelona,​​​​”the Institute’s priority objectives are to disseminate the prevalence of CKD and the anemia associated with it, to contribute to increasing its diagnosis and its clinical implications and to obtain a appropriate referral to the nephrologist for appropriate treatment. In addition to promoting research on aspects related to renal anemia.” These are long-term goals, the results of which will be seen in the coming years, “we want to have a 360º view of the path of the patient with renal anemia, define the goals and the best possible management in an integrated way. As well as the consequences of anemia on different elements of cardiovascular pathology, progression of kidney disease or quality of life, among others”, says Dr. José María Portolés, head of the Nephrology Service of the Puerta de Hierro Hospital in Madrid.


– Juan Manuel López Gómez, Soraya Abad Estebanez. Anemia in kidney disease. Updated Nephrology Journal No. 178.

– Cases, Aleix et al. “Anemia in chronic kidney disease: study protocol, management and referral to nephrology”. Nephrology (Madr.) [online]. 2018, vol.38, no. 1 [citado 2022-07-08]pp.8-12.

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