March is National Kidney Month, making today’s topic of Chronic Kidney Disease (also known as CKD) very fitting. A common issue of CKD is iron deficiency anemia, particularly for patients on dialysis.

What is Iron Deficiency Anemia?

Iron deficiency is a condition that reflects having less than adequate iron levels in the body which can occur due to an increased demand for iron (increased blood volume), iron loss (due to blood loss), or reduced absorption. Red blood cells carry oxygen throughout the body via hemoglobin; hemoglobin binds to oxygen and enables red blood cells to supply oxygenated blood throughout the body. Iron is a necessary component of hemoglobin production, thus, when the body experiences a lack of iron the result is decreased production of hemoglobin and less oxygen reaching the body’s muscles and tissues.

Iron deficiency is progressive; the final stage is iron deficiency anemia (IDA), in which chronic iron insufficiency causes the body’s iron stores to become depleted to the point where it can no longer produce adequate hemoglobin for its red blood cells.

The Complication of Anemia with CKD

With CKD, the damaged kidneys aren’t able to function as normal and cannot produce enough erythropoietin (EPO), a hormone required to make red blood cells. So, if the body doesn’t have enough EPO, the bone marrow will produce fewer red blood cells, which may lead to anemia (resulting in less oxygen supplied to your tissues and organs). It is possible for anemia to occur before the kidneys fail.

The main causes of IDA in those with CKD may include:

• Impaired absorption of dietary iron
• Blood loss
• Chronic inflammation
• Increased iron requirements (due to therapy with erythropoiesis-stimulating agents)

It isn’t just the condition itself that can cause iron deficiency, but also the treatment. Dialysis can cause a small amount of blood loss. That small amount of blood left in the dialyzer at the end of each treatment may not seem like much, but it adds up over time in someone with CKD. Dialysis also requires dietary changes, such as limiting iron-rich foods like red meat and beans which can also lead to lowered iron levels. Your altered diet can also leave you deficient in other nutrients that can impact iron levels, including folic acid and B12.

How Do You Know if it’s Iron Deficiency?

Iron deficiency can cause several symptoms, with the most common being:

• Chronic fatigue
• Difficulty concentrating
• Irritability or mood swings
• General weakness
• Headaches
• Pale skin
• Dizziness
• Rapid or irregular heart beat

Along with knowing the symptoms, your doctor can order blood tests to diagnose iron deficiency.

How Can IDA in CKD be Treated?

Erythropoiesis stimulating agents (ESAs) are drugs that are used to replace the EPO the kidneys aren’t able to produce with CKD. Given by injection, ESAs are utilized to increase red blood cell production (which increases iron needs); intravenous (IV) iron may be needed to ensure that the body has a sufficient supply of iron (ESAs actually deplete iron stores, which means that if there is not enough iron in the body to begin with, ESAs will be ineffective).

The amount of ESAs administered can be lowered if you’re able to increase your iron levels using other methods, like an iron-rich diet and iron supplements. Your doctor can refer you to a dietician that is familiar with the needs of those with CKD, who can make recommendations to help you increase your iron intake.

This article was last updated on 5.19.2015

Content and advice provided on The Iron Maiden is for information purposes only and should not serve as a substitute for a licensed health care provider, who is knowledgeable about an individual’s unique health care needs