CKD often leads to anemia, the failure of the body to produce enough red blood cells necessary for carrying oxygen from the lungs to the tissues throughout the body. The kidneys produce a hormone called erythropoietin (EPO) which triggers bone marrow to produce new red blood cells. With CKD, as kidney function decreases, the production of EPO decreases which in turn decreases the production of red blood cells resulting in anemia. The severity of anemia increases as kidney function decreases.

The degree to which a patient develops anemia is also impacted by nutrition, blood loss, other illnesses and chronic infections.


  • Fatigue
  • Decreased ability to carry out physical activities
  • Increasing shortness of breath
  • Difficulty concentrating
  • Memory loss
  • Pale skin
  • Brittle nails
  • Chest pain
  • Cold hands and feet


Testing & Treatment Options

In stages 1 and 2 of CKD, it is important to determine whether anemia is a result of poor kidney function or another cause. Once the cause is determined, a plan of action can be put in place.

In stages 3, 4 and 5 of CKD, it is important to closely monitor hemoglobin and iron status.

  • Monitor complete blood count
  • Transferrin Saturation and Ferritin testing for iron deficiency – if either level is low, an oral iron supplement may be prescribed
  • Blood test for B12 and folate – if these are low, oral supplements can be taken
  • Reticulocyte test, to determine the percentage of young red blood cells in the blood, reveals either an inadequate production of red blood cells or a loss of red blood cells.
  • Eat an iron-rich diet of meat and dark leafy green vegetables – if recommended by your provider
  • Intravenous Iron if needed
  • Erythropoiesis Stimulating Agents (ESAs) are drugs that mimic the body’s natural erythropoietin to increase production of red blood cells.