Anaemia in Kidney Disease: Causes, Symptoms & Treatment

Feeling tired even after a full night's sleep, getting breathless during routine activities or struggling to concentrate can affect everyday life. These symptoms may have several causes, but they can also indicate what anaemia and kidney disease patients commonly experience as kidney function declines.

The good news is that appropriate testing and treatment can help manage the condition, improve symptoms and support daily activities.

What Is Anaemia in Chronic Kidney Disease?

Anaemia is a common complication of chronic kidney disease (CKD) that usually develops when the body does not have enough healthy red blood cells to carry oxygen to its tissues.

How Healthy Kidneys Help Make Red Blood Cells

Healthy kidneys produce erythropoietin (EPO), a hormone that signals the bone marrow to make red blood cells. When CKD damages the kidneys, EPO production may decline, which is why anaemia in kidney disease can develop even when a person eats a reasonably balanced diet.

How Common Is Anaemia in CKD?

The risk of anaemia generally increases as kidney disease progresses. While it can occur at different stages, its severity varies between individuals depending on the underlying medical condition, such as diabetes, as well as whether or not the person receives dialysis.

Causes of Anaemia in Kidney Disease

Several factors can contribute to anaemia in kidney disease. More than one cause may be present at the same time, so identifying the underlying problems is an important part of treatment.

• Low Erythropoietin (EPO) Production

Damaged kidneys may produce less EPO, leaving the bone marrow without enough stimulation to make red blood cells.  

• Iron Deficiency

People with CKD may develop iron deficiency because of blood loss, reduced iron availability or increased iron requirements during treatment. Inflammation can also make stored iron harder for the body to use.

• Vitamin B12 and Folate Deficiency

Vitamin B12 and folate support normal red blood cell production. Low levels of either nutrient can contribute to anaemia, although these deficiencies are not present in every person with CKD.

• Blood Loss During Dialysis and Frequent Blood Tests

People receiving haemodialysis may lose small amounts of blood during treatment, through blood tests or from bleeding at the dialysis access site. Repeated losses can lead to iron deficiency over time.

• Inflammation

CKD-related inflammation can interfere with the body's use of stored iron and reduce the bone marrow's response to EPO. Infections and other inflammatory conditions may worsen the problem.

Symptoms of Anaemia in CKD

Anaemia can develop gradually, so early symptoms may be difficult to recognise. However, here are some common symptoms to watch out for:

• Persistent tiredness, weakness or low energy.
• Breathlessness during activity.
• Pale skin or the inside of the lower eyelids.
• Dizziness, headaches or light-headedness.
• Difficulty concentrating or sleeping.
• A fast or irregular heartbeat.

How Anaemia in Kidney Disease Is Diagnosed

Your healthcare team may use blood tests and a review of your medical history to determine whether anaemia is present and what is causing it.

• Haemoglobin and Complete Blood Count (CBC)

A complete blood count measures haemoglobin and provides information about red blood cells and other blood components. The results help identify anaemia and assess its severity. Haemoglobin levels must be interpreted according to factors such as age, sex, pregnancy status and clinical circumstances.

• Iron Studies: Ferritin and Transferrin Saturation

Ferritin provides information about the body's stored iron, while transferrin saturation (TSAT) helps assess how much iron is available for use. Depending on the situation, your doctor may also request vitamin B12, folate, reticulocyte count or tests for blood loss and inflammation.

Treatment Options for Anaemia in CKD

The right approach to managing CKD and anaemia treatment depends on the underlying cause, haemoglobin level, symptoms, dialysis status and other health conditions.

Iron Supplements: Oral and IV

If tests indicate iron deficiency or insufficient available iron, your doctor may recommend oral iron tablets or intravenous (IV) iron.

• Oral iron is taken by mouth and may be suitable for some people who are not receiving haemodialysis.
• IV iron delivers iron directly into a vein and is commonly used in haemodialysis care.

Erythropoiesis-Stimulating Agents (ESAs)

ESAs act like the body's natural EPO and stimulate red blood cell production. They may be prescribed when anaemia persists after correctable causes, such as iron deficiency, have been addressed. These medicines may reduce symptoms and the need for blood transfusions.

HIF-PH Inhibitors: Newer Oral Medicines

Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are oral medicines that stimulate the body's natural pathways involved in EPO production and iron regulation. They may be considered in selected patients, depending on local approval, availability and clinical circumstances.

Blood Transfusion

A blood transfusion may be needed when anaemia is severe or requires urgent correction. However, transfusions are used carefully in people with CKD because they can cause complications and may lead to antibodies that make a future kidney transplant more difficult.

For this reason, treatment of anaemia in CKD is usually planned around the person's symptoms, laboratory results and overall health rather than a single haemoglobin value.

Managing Anaemia Day to Day

Medical treatment is often the main way to manage anaemia in chronic kidney disease, but everyday habits can support overall health.

Kidney-Friendly Iron-Rich Foods

Include suitable sources of iron and protein in your meals, while following your individual kidney diet. Options may include:

• Lean meat, fish and eggs, where appropriate.
• Iron-fortified cereals, if suitable for your dietary plan.
• Beans, lentils and leafy vegetables in portions that fit your potassium and phosphorus restrictions.
• Foods containing vitamin C, which can help the body absorb iron from plant foods.

Anaemia Monitoring During Dialysis

Regular monitoring helps your team assess whether your treatment is working and whether adjustments are needed. Your dialysis team may also review haemoglobin, ferritin, TSAT and other tests at intervals based on your condition and treatment.

Conclusion

Anaemia during kidney disease can develop due to reduced erythropoietin (EPO) production, iron deficiency, and inflammation, which can interfere with red blood cell production. Identifying the cause through blood tests allows your healthcare team to choose suitable treatment and monitor its effects. With regular follow-up, kidney patients can manage their symptoms and maintain their daily routines.

NephroPlus provides in-clinic dialysis, home haemodialysis, dialysis on wheels, dialysis on call and holiday dialysis. Speak with our kidney care team about your dialysis and anaemia management needs and confirm service availability before making arrangements.

FAQs

Why do kidney patients become anaemic?

Damaged kidneys may produce less EPO, the hormone that signals the bone marrow to make red blood cells. Iron deficiency, inflammation, vitamin deficiencies and blood loss can also contribute to this condition.

At what stage of CKD does anaemia usually start?

Anaemia becomes more common as CKD progresses, particularly during stages 3 to 5. However, it can develop earlier, depending on other health conditions and nutritional factors.

Can anaemia in kidney disease be cured?

It depends on the cause. Correcting iron or vitamin deficiencies may resolve some cases, while anaemia caused by reduced kidney function often requires ongoing monitoring and treatment.

Are EPO injections safe for CKD patients?

ESAs are widely used when clinically indicated, but they carry risks, including high blood pressure and blood clots. Doctors individualise treatment and monitor haemoglobin to reduce these risks.

What foods help increase haemoglobin in kidney patients?

Suitable sources include lean meat, fish, eggs, fortified cereals and selected plant foods. The right choices depend on iron status and individual potassium and phosphorus restrictions, so a renal dietitian can help plan meals.