Episode Description:
As renal function declines, anemia becomes increasingly prevalent, impacting morbidity and mortality rates among CKD patients. Anemia in CKD is primarily driven by decreased erythropoietin production, iron deficiency, and inflammation-induced changes in iron homeostasis and erythropoiesis. The kidneys normally produce erythropoietin in response to hypoxia, stimulating red blood cell production. In CKD, damaged nephrons produce insufficient erythropoietin, leading to reduced erythropoiesis. Additionally, iron deficiency results from poor gastrointestinal absorption, frequent blood losses, and reduced dietary intake. Inflammation in CKD increases hepcidin levels, inhibiting iron absorption and trapping iron in storage sites.
Diagnosing anemia in CKD involves evaluating hemoglobin levels, red blood cell indices, reticulocyte count, and iron status. According to KDIGO guidelines, anemia is suspected when hemoglobin levels fall below 13 g/dL in men and 12 g/dL in women. A complete blood count (CBC), serum ferritin, and transferrin saturation are essential components of the diagnostic workup. Additional tests for vitamin B12 and folate levels may be required if macrocytosis is present, and a bone marrow biopsy may be necessary to rule out other causes of anemia.
Treatment of anemia in CKD involves addressing its specific causes through four main approaches:
- Erythropoiesis-Stimulating Agents (ESAs): ESAs mimic the action of erythropoietin, effectively treating anemia. However, careful monitoring is required to avoid potential risks such as hypertension and increased cardiovascular events.
- Iron Supplementation: Both oral and intravenous iron supplements are used to manage iron deficiency. Intravenous iron is often preferred in severe cases due to better efficacy and fewer gastrointestinal side effects.
- Vitamin Supplementation: Supplementation with vitamins like B12 and folic acid is necessary for patients with detected deficiencies.
- Emerging Therapies: Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) promote endogenous erythropoietin production and improve iron regulation, presenting a promising alternative to traditional ESAs.
Anemia in CKD significantly affects the quality of life and survival of patients. Understanding its pathophysiology and implementing effective diagnostic and treatment strategies are crucial for managing this condition.
Renes Care Radio is a podcast designed for nephrology professionals, offering in-depth scientific explorations of key topics. It equips kidney care providers with the essential knowledge needed for advanced patient care.
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