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 .
