Do you struggle with feeling cold, tired, dizzy, or short of breath? These could be signs of anemia—a related medical condition that is common among people with kidney disease. The American Kidney Fund (AKF) explains everything you need to know about anemia and chronic kidney disease, including the types, causes, symptoms, tests, and treatment options for those with CKD.*

What is anemia? 

In every person’s bloodstream, there are red blood cells that carry oxygen to your muscles, bones, and organs. Oxygen, in particular, is key to ensure your body is working properly and that you have the energy to do your daily activities. Anemia happens when your body is low on red blood cells.  

What causes anemia?  

There are numerous causes, but the two main causes for people with CKD are:  

1. CKD and erythropoietin: The average red blood cell lives 115 days, so new red blood cells are being made constantly. Your kidneys help to make red blood cells through a hormone, or messenger, called erythropoietin (EPO). Without EPO, your body doesn’t know how to make more red blood cells.
2. CKD and iron: Another component that helps to make red blood cells is iron. Iron deficiency anemia is common among people with CKD. This is because it can be difficult to eat enough iron, but it can also come from blood loss (due to multiple blood tests and/or dialysis).  

What are the risk factors?

Most people with kidney disease will develop anemia, and it may grow worse as your CKD progresses. 

Anemia is also commonly seen in the following demographics, populations, and related conditions: 

• Black people
• Older than 75 years of age
• Females
• Diabetes
• Heart disease
• High blood pressure
• Moderate or severe loss of kidney function (stage 3 or 4 CKD)
• Kidney failure (stage 5 CKD)

What are the symptoms of anemia?

Anemia can cause you to: 

• look pale;
• feel tired and/or cold;
• have a poor appetite;
• have trouble sleeping and/or thinking clearly;

• feel dizzy and/or have headaches;
• have a rapid heartbeat and/or chest pain;
• feel short of breath; and
• feel down and/or depressed.

How is anemia diagnosed? 

Anemia is easily diagnosed with a blood test. If you have kidney disease, this is likely to be monitored by your doctor regularly. Anemia can slowly develop over time, so call your doctor immediately if symptoms have worsened or become severe.  

How is anemia treated?

Your treatment plan will depend on the type of anemia you have. The following treatment options are common among people with CKD: 

• Erythropoiesis-stimulating agents (ESAs): ESAs will help your body make red blood cells. They are usually given as an injection under the skin. 
• Nutrition changes: If you are iron deficient or deficient in another anemia related nutrient, such as folic acid or Vitamin B12, your doctor may recommend an oral supplement. They may also have you modify your diet to include foods that are high in iron, Vitamin B12, or folic acid. 
• Red blood cell transfusion: Commonly given in a hospital setting, this treatment can temporarily and immediately improve your anemia symptoms. Red blood cells (donated by another person) are given to you through intravenous (IV) therapy.

Additional information can be found on the National Kidney Foundation (NKF) page on “Anemia and Chronic Kidney Disease.”

*American Kidney Fund. (n.d.). Anemia in chronic kidney disease. https://www.kidneyfund.org/anemia/