The goal in treating anemia in chronic kidney disease (CKD) is to help your body make more healthy red blood cells. The exact treatment you'll get depends on what causes your anemia and your symptoms.
Your doctor may prescribe:
- Medicine
- Iron supplements
- A blood transfusion
You might also take vitamins or make changes to your diet to get the blood-building nutrients you need.
Medicines
Erythropoiesis-stimulating agents (ESAs) work like a natural hormone that your kidneys make. The hormone, named erythropoietin (EPO), tells your bone marrow to make red blood cells.
When your kidneys can't make enough EPO, ESAs may help.
You usually get an ESA as a shot in your doctor’s office. You can also give yourself shots at home. If you’re on dialysis, you may get an ESA through a vein (IV) during your treatment.
Common side effects of ESAs are:
- High blood pressure
- Fever
- Dizziness
- Nausea
ESAs can also cause:
- Blood clots in your lungs
- A higher chance of a heart attack, stroke, and heart failure
- Creation of antibodies to the ESA that stop your body from making red blood cells (rare)
Your doctor may not prescribe an ESA if you have:
- Uncontrolled high blood pressure
- Heart disease, strokes, or seizures
- A history of cancer
Talk to your doctor if you’re pregnant, if you plan to have a baby, or if you breastfeed. It’s important to know the pros and cons of ESAs so you can decide if they’re right for you.
There's also a newer class of medicines called hypoxia-inducible factor prolyl hydroxylase enzyme inhibitors (HIF-PHIs). They help your body make more red blood cells by raising your EPO levels. You would get this as a pill. None are currently approved in the USA.
Common side effects of HIF-PHI medicines include:
- High blood pressure
- Nausea
- Diarrhea
Vitamins and Supplements
When your body doesn't take in enough iron, you may need to take a supplement.
You'd take it as pills or through an IV in your doctor’s office or clinic. If you’re on dialysis, you may get the IV during your treatment.
You need extra iron when you take an ESA. It helps the medicine work well. It may allow you to take a lower dose of the ESA, too.
Vitamin B12 and folate (B9) help make red blood cells. Your doctor may prescribe them if you don’t take in enough through food.
Diet Changes
What you eat can help you manage anemia and make you feel better. But it can be tricky to find the right eating plan when you have CKD.
Some iron-rich foods, like red meat, may have too much protein and phosphorus for people with kidney disease. It’s best to work with a dietitian who can design a nutrition plan that manages both anemia and CKD. Your doctor can help you find one.
Blood Transfusion
This may be an option if your anemia is severe or if an ESA isn't right for you. You'd get red blood cells from a donor through a vein in your arm. This usually takes place in a hospital or outpatient center.
The transfusion can last from 1 to 4 hours. It pumps a lot of red blood cells into your body and may ease your symptoms for a time. Still, doctors try to avoid or limit them because they can cause other health problems, such as:
- Generating antibodies that may prevent you from having a kidney transplant later
- A buildup of iron that can damage organs like your liver, heart, and pancreas
- Reactions to the transfusion
If you have heart failure, blood transfusions can also cause fluid to build up in your lungs that can make it hard to breathe.