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Nephrology Associates of Kentuckiana, PSC provides care for all aspects of the prevention and treatment of kidney disease. Anemia is often a side effect of kidney diseases and can occur as early as Stage 3. Anemia is the condition defined as insufficient red blood cells. Red blood cells carry oxygen from your lungs to all parts of your body, giving you the energy you need for your daily activities.  Anemia can cause you to:

  • Look pale

  • Feel tired

  • Have little energy for your daily activities

  • Have a poor appetite

  • Have trouble sleeping

  • Have trouble thinking clearly

  • Feel dizzy or have headaches

  • Have a rapid heartbeat

  • Feel short of breath

  • Feel depressed or “down in the dumps”

FAQ about Anemia


Why do people on dialysis get anemia?
Your kidneys make an important hormone called erythropoietin (EPO). Hormones are secretions that your body makes to help your body work and keep you healthy.  EPO tells your body to make red blood cells. When you have kidney disease, your kidneys cannot make enough EPO. This
causes your red blood cell count to drop and anemia to develop.  [TOP]

Are all people on dialysis at risk for anemia?
Most people with kidney disease will develop anemia. Anemia can happen early in the course of kidney disease and grow worse as kidneys lose their ability to work well and make EPO. Anemia is especially common if you:

  • Have diabetes

  • Are African American

  • Have moderate or severe loss of kidney function (stage 3 or 4)

  • Have kidney failure (stage 5)

  • Are female  [TOP]

How is anemia treated?
If your anemia is due to kidney failure, you will be treated with:

  • Drugs called erythropoiesis-stimulating agents (ESAs). ESAs act like the natural hormone EPO, which helps your body
    to make red blood cells.

  • Extra iron. Your body also needs iron to make red blood cells—especially if you are receiving ESAs. Without enough iron, your ESA treatment will not work.  [TOP]

What is the goal of anemia treatment?
The goal of anemia treatment is to increase your hemoglobin level to at least 11, which is considered to be the lowest level of hemoglobin you need to feel well. As you get closer to or pass this level, you should notice that you have more energy and feel less tired.  [TOP]

How is ESA given?
ESAs can be given to you in the following ways:

  • As an injection under the skin. This is called a subcutaneous injection (SC).

  • Injected through the blood tubes during dialysis. This is called an intravenous injection (IV).  You and your doctor will decide which method is best for you.  How much ESA will I need?  Your doctor will prescribe enough ESA to increase your hemoglobin gradually to the recommended level. How much ESA you need and how often you receive it depends on:

    - Your current hemoglobin level
    - How well you respond to treatment with ESA
    - The type of ESA you receive

Two different types of ESAs are available—short-acting ESAs and long-lasting ESAs. Short-acting ESAs are more effective when given subcutaneously (as an injection under the skin) rather than by IV (through the blood tubes during dialysis). Examples of short-acting ESAs are epoetin alfa and epoetin beta. Long-lasting ESAs are equally effective
regardless of how they are given. Darbepoetin is an example of a long lasting ESA.  [TOP]


How is my iron level tested?
Two important tests can tell if you have enough iron. They are called transferrin saturation (TSAT) and ferritin. To make sure you have enough iron to reach the recommended hemoglobin:

  • Your TSAT should be at least 20%

  • Your ferritin should be:

- Greater than 200 ng/mL (when you
are on hemodialysis)
- Greater than 100 ng/mL (when you
are on peritoneal dialysis)

How will iron be given to me?
Iron is most effective when given by IV. IV iron can be injected into the blood tubes during hemodialysis. For patients receiving peritoneal dialysis, iron can be given either by IV or as a pill by mouth.  [TOP]

Can diet help my anemia?
Eating foods that are high in iron, vitamin B12 and folic acid may be helpful for some patients with anemia. Your dietitian can help you plan meals to include foods that are good sources of these vitamins and minerals. Check with your doctor before making any changes in your diet.  [TOP]

How long will I need anemia treatment?
You will probably need treatment for life—even if you have a successful kidney transplant. Unfortunately, even a new kidney may not be able to make all the EPO you need to make enough red blood cells. One reason this happens is because the immunosuppressive drugs needed after getting a new kidney can affect EPO production. So medication for anemia may still be needed even after a successful transplant.   [TOP]

What if my anemia isn’t treated?
If untreated, anemia can cause serious problems. Anemia can make your other health problems worse. A low supply of red blood cells in your body (anemia) can make your heart work harder. This can lead to a type of heart disease called left ventricular hypertrophy (LVH). Unfortunately, many people with kidney disease develop LVH long before they reach kidney failure, and some will even die from it. Early treatment of anemia may help prevent this problem and other serious complications from happening.  [TOP]


Comprehensive Renal Care Clinic
Anemia Management
Hypertension Management
Chronic Kidney Disease Education
Risk Factor Reduction
Use of Electronic Medical Record
Nutrition – Renal Vitamins


Is to provide the highest quality, most comprehensive and up-to-date care for patients with kidney disease in a courteous, respectful, and timely manner.


6400 Dutchmans Pkwy, Suite 250
Louisville, KY 40205
Phone: 502-587-9660
Fax: 502-540-5615

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© 2011 Nephrology Associates of Kentuckiana, PSC
6400 Dutchmans Parkway  |  Louisville, KY  40205
502-587-9660  |  502-540-5615 fax

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