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Anemia & Kidney Disease

Kidneys make a hormone called erythropoietin (EPO) that, in-turn, makes blood. When kidneys are not working at their fullest, patients can have low red blood cell count called anemia.

EPO needs iron to make blood. We generally get iron from a healthy diet. Sometimes, kidney patients need extra iron supplementation, either as pills or intravenously (IV).

Red blood cells carry oxygen to tissues. Without oxygen, your tissues and organs, particularly the heart and brain, may not do their jobs as well as they should. Anemia prevents many people with kidney disease from feeling their best. Appropriate treatments will help patients feel better, live longer, and have more energy.

Laboratory tests

A complete blood count (CBC) is a laboratory test performed on a sample of blood. It measures the amount of hemoglobin (Hgb) in the blood which is the component of red blood cells that carry oxygen.

When anemia begins

Anemia may begin to develop in the early stages of kidney disease when you still have 20 to 50 percent of your normal kidney function. Anemia tends to worsen as kidney disease progresses.


If you have a Hgb of 11 or less, you are considered anemic with the most likely cause being decreased EPO production. An evaluation by a physician is necessary and will include tests for iron deficiency and blood loss in the stool to be certain there are no other reasons for the anemia.


If you are anemic, your physician will recommend one of more of the following treatments:

Eating healthy, iron-rich meal
Checking and replacing iron either by pills or IV as decided by your nephrologist
Giving EP under the skin or in the veins as decided by your nephrologist