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Date issued: October 2023

Review date: October 2025

Ref: B-491/JM/Renal/Your guide to anaemia

PDF: Your Guide to Anaemia.pdf[pdf] 548KB

This leaflet is designed to:

• Explain what is renal anaemia

• Signs and symptoms

• How is it diagnosed

• Treatment for anaemia

What is renal anaemia?

Anaemia occurs when there are too few red blood cells in the blood. Red blood cells contain haemoglobin (Hb) which transports oxygen from the lung to the rest of the body to give you energy. When the red cell count is low, blood oxygen levels are low.

Healthy kidneys recognise this and produce a hormone called erythropoietin (EPO) which stimulates production of red blood cells in the bone marrow. When the kidney start to fail, little or no EPO is produced and this results in a failure of red blood cell production.

Another factor that can cause anaemia in kidney disease can be iron deficiency as iron is not absorbed so well when your kidneys start to fail. This leads to renal anaemia.

What are the symptoms of anaemia?

• Lack of energy

• Feeling tired

• Feeling cold

• Breathlessness on exertion

• Difficulty in performing everyday tasks

• Difficulty concentrating

• Sexual dysfunction

• Inability to sleep

How is anaemia diagnosed?

Anaemia is identified by a blood test that measures your levels of haemoglobin (Hb). In a healthy adult Hb levels should be above 120-130g/dl, however, for people with  renal failure , NICE (National Institute for Clinical Excellence) guidelines suggest we aim for a Hb 105-125g/l.

How is renal anaemia treated?

Erythropoietin

Treatment varies depending on the cause of your anaemia. If you have erythropoietin (EPO) deficiency you will be given an erythropoietic stimulating agent (ESA) to help your body produce more red blood cells. ESA’s are an artificial EPO hormone, which is given as an injection. You can either inject this yourself or we can arrange for either your practice nurse or district nurse to administer the injection.

A common side effect of taking EPO is a rise in your blood pressure, therefore this needs to be monitored closely whilst you are receiving EPO injections.

With higher energy levels and less breathlessness, most people notice a benefit from EPO within a month or two of starting. Treatment is usually continued indefinitely but the dose and frequency may change over time.

Regular blood tests will be required to monitor your Haemoglobin (Hb) and any changes to your dose or frequency will be discussed with you.

Iron

If your anaemia is caused by iron deficiency you will require iron supplementation. Iron is a major ingredient in the red blood cells, helping them to function correctly. Iron deficiency is common in kidney disease and sometimes giving iron alone can be enough to treated renal anaemia. Iron can be given in a tablet form but when your iron stores are very low the choice of treatment is to give iron directly into your vein.

This involves attending the clinic for a short infusion. A needle is placed into a vein in the arm or hand and an Iron solution is then injected or infused  into your veins. This can take between 15 minutes to 1 hour depending on the dose of the iron.

As with all medications Iron can cause side effects although not everyone gets them. Common side effects you may experience on treatment are;

• Headache

• Dizziness

• Nausea

• High blood pressure/Low blood pressure

• Flushing

All these side effects are rare

Useful Contacts

CKD Team

You can contact us on the below number Monday to Friday 8am to 4pm. If your query is not urgent please leave a message and we will get back to you.

01752 430310

For any urgent queries out of hours please contact Mayflower Ward, 01752 431485

Below are other useful contacts within the department

Dietitian 01752 439961

Plymouth Dialysis Unit 01752 431700

Kingsbridge Dialysis Unit 01752 438250

Saltash Dialysis Unit 01752 278451

Holsworthy Dialysis Unit 01626 923807