Anemia in Patients With Chronic Kidney Disease

Anemia is one of common symptoms in CKD Patients . Do you want to know the common causes of Anemia,The Impact of Anemia and how to treatment Anemia in CKD?Follow me and find the answer for these questions .

Anemia, as defined by the NKF, is a hemoglobin (Hb) concentration < 12 g/dl for women and < 13.5 g/dl for men.3 Conversely, the European Best Practices Guidelines for the Management of Anemia in Patients with Chronic Renal Failure defines anemia according to age and sex. Anemia is defined as an Hb concentration of < 11.5 g/dl in women, < 13.5 g/dl in men ≤ 70 years of age, and < 12 g/dl in men > 70 years of age.4 In patients receiving dialysis, the recommended Hb target value is ≥ 11 g/dl in women and ≥ 12 g/dl for men. Regardless of the definition, anemia is a common complication associated with CKD.

Causes of Anemia

Diabetes is one of the most common causes of CKD. Although patients with diabetes are regularly monitored for a variety of complications, such as neuropathy, nephropathy, and retinopathy, Hb concentrations frequently are not routinely assessed. Interestingly, reductions in Hb often occur before the onset of overt diabetic nephropathy.
This reduction in Hb occurs for a variety of reasons. Approximately 90% of the hormone erythropoietin is produced by the kidneys. Under normal physiological conditions, hypoxia in the kidney leads to an increase in the production of erythropoietin, which subsequently stimulates erythropoiesis.8 The kidney, in turn, senses increased oxygenation because of the formation of the new erythrocytes and decreases erythropoietin production. However, tubulointerstitial damage associated with diabetes occurs early in the course of diabetes, even before a reduction in GFR or albuminuria is noted.9As functional renal tissue declines in patients with CKD, the body is unable to produce adequate amounts of erythropoietin in response to hypoxia in the kidney.8 Another factor commonly seen in patients with diabetes is the use of medications that may adversely affect Hb production. These include metformin, fibrates, thiazolidinediones, and angiotensin-converting enzyme inhibitors. Finally, systemic inflammation associated with microvascular disease in patients with diabetes leads to the production of inflammatory mediators, such as interleukins and tissue necrosis factor. These mediators blunt the effect of erythropoietin on the bone marrow, where erythroid precursors are stimulated.9
Other factors, although not specific to patients with diabetes, further exacerbate anemia in patients with CKD. These include platelet dysfunction leading to an increased risk of gastrointestinal bleeding, shortened erythrocyte survival time (30–60% of the normal 120 days), and hemolysis secondary to uremic toxin accumulation. In patients receiving dialysis and especially those on hemodialysis, chronic blood loss resulting from frequent phlebotomy for laboratory studies and loss of blood in the dialysis tubing and dialyzer after each hemodialysis treatment may also contribute to declining Hb values. Finally, malnutrition and deficiencies of iron, folate, and vitamin B12have been found to cause a reduction in Hb concentrations.10

Impact of Anemia

The impact of anemia on patients with CKD is profound. In addition to the well known symptoms of fatigue, dizziness, and shortness of breath, anemia has been associated with more severe adverse outcomes, such as cardiovascular complications including left ventricular hypertrophy and congestive heart failure. In patients with diabetes, anemia has been associated with a decline in kidney function, which often occurs in patients with diabetes. Hypoxia caused by anemia stimulates the renin-angiotensin-aldosterone system and contributes to renal vasoconstriction. These factors further exacerbate proteinuria by increasing protein in the renal tubules in patients with diabetes.9 Of note, in patients with type 2 diabetes, anemia has been shown to be an independent risk factor associated with the loss of kidney function.11 In patients with diabetes, anemia can also contribute to the severity of cardiovascular disease and independently increase the risk of retinopathy. Anemia is also thought to hasten the progression of diabetic neuropathy.11 Other general complications associated with anemia include reduced cognitive function and mental acuity, impaired quality of life, and the need for blood transfusions.12–15
Correction of anemia has been shown to improve cardiac function possibly by reducing exercise-induced myocardial ischemia.12Treatment of anemia associated with CKD has also been shown to result in improvements in exercise capacity; physical performance features such as endurance; energy; and physical mobility.13 Patient satisfaction increases when anemia is corrected, as evidenced by higher quality-of-life scores, improved sexual function, better cognition, less depression, and better socialization.14 In non–dialysis-dependent CKD patients, stabilization of renal function has been associated with treatment of the anemia of CKD.12 Finally, treatment of anemia has been shown to reduce hospitalization and mortality rates.

As a result of the potentially severe consequences of anemia in CKD, early recognition and management of anemia are imperative. Consequently, monitoring Hb and detecting anemia in patients with diabetes is essential.

Treatments of Anemia in CKD Patient

Some Chinese herbs can treat your Anemia. Micro-Chinese Medicine Osmotherapy  combined Chinese herbs with a Machine .Through this Machine the Chinese herbs can permeate your kidneys directly . So it will take quickly effect .

If you have interested in this therapy .Or if you want to get more suggestions about your kidney disease . Consult me through kidney-treatment@hotmail.com .