Anemia is a frequent complication of chronic kidney failure. In patients with CKF, normochromic normocytic anaemia mainly develops from decreased renal synthesis of erythropoietin. The anaemia becomes more severe as the GFR progressively decreases. No reticulocyte response occurs, red blood cell survival is decreased, and there is an associated increased bleeding tendency due to uraemia-induced platelet dysfunction.
Anemia can make you feel weak, tired, and short of breath. You may also have headaches and trouble sleeping. You may also experience a loss of appetite and a more rapid heart rate and cardiovascular consequences, such as left ventricular hypertrophy and left ventricular systolic dysfunction. It is also associated with an increased risk of morbidity and mortality, principally due to cardiac disease and stroke, and with an increased risk of hospitalization, hospital length of stay, and mortality in patients with predialysis CKF .
Dialysis itself may also contribute to the anemia. Iron deficiency can result from unavoidable dialyzer blood loss, clotted dialysis membranes, and frequent blood sampling. Hemolysis may occur if there are problems with the dialysate. Folate, a water soluble vitamin necessary for normal red blood cell production, is dialyzable. Generally, dialysis patients are given oral supplementation with folic acid in case their normal diet does not supply them with sufficient folate to keep up with its loss through dialysis.
For many people with kidney disease, iron supplements have an important role in improving your anemia. The treatment of the anemia of chronic renal failure has changed dramatically in recent years. Until recently, the principal treatments were transfusion of red blood cells and administration of the hormone testosterone. Although transfusions will rapidly correct a low blood count, repeated transfusions are associated with some problems, including iron overload, the development of certain antibodies, and the possibility of viral infections. Testosterone may stimulate red blood cell production by the bone marrow, but the effect is generally small, and its use is often associated with virilizing side effects.