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Chapter 3 Side Effects of Chronic Kidney Disease

03 March 2018


Anemia is a condition in which the body does not have enough red blood cells. Red blood cells carry oxygen throughout your body. Oxygen acts like fuel for the body, providing energy for muscles and organs to work. It is the lack of oxygen that causes fatigue, main symptom of anemia. Other symptoms are dizziness, headaches, inability to concentrate, shortness of breath, etc. How you describe fatigue will depend on your lifestyle and how fatigue is affecting it. For example a simple walk may seem like a 10 km run. It is important to talk to your doctor about your condition.

What can be done to prevent or control anemia?

As a person with CKD you may not making enough erythropoietin and your doctor may prescribe a special medication. This medication is a man-made form of erythropoietin called erythropoietin stimulating agents or ESAs. It may given by injection. Taking iron by mouth (oral iron) is important while taking ESAs. As new red blood cells are being formed, they need iron to support their growth and this why oral iron is needed. Some patients taking ESAs need to receive iron though vein. The amount of iron your body keeps stored will not be enough to make all the new red blood cells you need.

How will my doctor know if I am anemic?

A blood test will give your doctor a picture of how many and how healthy your blood cell are. It will show if you are anemic.

The most common blood cell tests are:

Hemoglobin, εtarget range for CKD patients receiving ESAs: 10-12 g/dl
Hematocrit, target range for CKD patients receiving ESAs: 30-36%

The iron blood cells tests are:

Ferritin: This is a protein that keeps iron in “storage” until it is needed. To optimize blood cell production, your serum ferritin should be maintained greater than 100 ng/ml if you have CKD not on dialysis or peritoneal dialysis and greater than 200 ng/ml if you are on dialysis. Your doctor will know when to start iron administration and when to stop it.

Transferrin saturation: Tranferrin is a protein that takes the iron from the storage protein (ferritin), or the iron that you are being treated with, and takes it the bone marrow where it may be used to build healthy red blood cells. This blood test measures the amount of iron on the the transferrin protein. If your transferrin saturation is less than 20 %, it means that you do not have enough iron for the red blood cells. The normal transferrin saturation range should be between 20-50 %.

What type of iron may my doctor prescribe?

There are two ways of taking iron if diet alone is not enough. Oral iron or intravenous iron, depends on the patient. Erythropoietin and iron work together to help your body make more healthy red blood cells.

How can I monitor my energy level?

The following chart will be an excellent reference for both you and your doctor to track your activity and activity as well as your hemoglobin level. To use this chart, record the date and your hemoglobin level and then place a “X” in the box that corresponds best to your energy level.

Download and print the Chart