Abbas Rabiei, M.D., F.A.S.N. practices Nephrology and Internal Medicine in Jupiter and Palm Beach Gardens specializing in Anemia of Chronic Kidney Disease. Call 561-253-8121 today for an appointment!
The incidence of anemia in patients with chronic kidney disease (CKD) increases as the patients with glomerular filtration rate (GFR) declines. Based on a study performed by the National Health and Nutrition Examination Survey (NHANES) the incidence of anemia is less than 10% in CKD stage 1 and 2, 20% to 40% in CKD stage 3, and 50% and 60% in CKD stage 4, and more than 70% in stage 5.
Factors that cause or contribute to anemia in patients with CKD is multifactorial:
- Insufficient production of endogenous erythropoietin (EPO)
- Iron deficiency
- Acute and chronic inflammatory conditions
- Aluminum toxicity
- Folate deficiency
- Decreased survival or red blood cells
The contribution of erythropoietin deficiency becomes greater as GFR declines. Because of their loss of functioning mass, the kidneys in patients with CKD fail to increase EPO production in response to anemia. The kidneys produce about 90% of circulating EPO, so loss of EPO production in the setting of CKD is the primary causes of anemia in these patients.
Clinical manifestations of anemia in patients with or without CKD are fatigue (both with exercise and at rest), decreased cognitive skills, loss of libido, and decreased sense of well-being. These symptoms tend to occur when the hemoglobin is less than 10 g/dL, and are more severe at lower hemoglobin. In patients with underlying coronary artery disease, anemia may lead to an exacerbation of angina symptoms because of decreased oxygen delivery to the heart.
The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines and clinical practice recommendations for anemia and CKD recommended annual screening of all patients with CKD (regardless of stage) for anemia. If patient is diagnosed with anemia, further evaluation should be undertaken to determine the cause of anemia.