Anaemia might begin to develop in the early stages of CKD, when someone has 20 to 50 percent of normal kidney function. Anemia tends to worsen as CKD progresses. Most people who have total loss of kidney function, or kidney failure, have anaemia. The main reason of anaemia in chronic kidney disease patients is reduced production of Erythropoietin (EPO) by the kidney. EPO prompts the bone marrow to make red blood cells. When the kidney’s function is decreased, the amount of EPO produced will be reduced. Other factors that cause anemia among dialysis patients are:
- Reduced red blood cell lifespan due to accumulated urea toxic
- Malnutrition
- Lack of iron
- Lack of folate and other vitamins
- Blood loss during haemodialysis
Adequate intake of protein, iron, vitamin C, vitamin B 12 and folate are important in preventing and treating anemia as these nutrients are the important elements in making new red blood cells.
Please read EPO section for details on EPO injection administering in CKD patients.
Packed red blood cells, also known as packed cells, are red blood cells that have been separated for blood transfusion. They are typically used in anemia that is either causing symptoms or when the hemoglobin is less than usually 70–80 g/L (7–8 g/dL). This is required by CKD patients in extreme anaemia. Packed red blood cells (PRBCs) are made from a unit of whole blood by centrifugation and removal of most of the plasma, leaving a unit with a hematocrit of about 60%. One PRBC unit will raise the hematocrit of a standard adult patient by 3%
NOTE: Very few blood banks store packed red cells so there is huge demand and long waiting time (sometimes months). So place a requisition for the same well in advance at the blood bank so that the same is available when patient is critical and requires packed cells infusion. Packed cells blood transfusion of more than one unit generally takes two days in the hospital. Since kidney patients are highly susceptible to infections, pneumonia, proper care must be given to the patient while in hospital. This is because hospitals have variety of ill patients and there is possibility of contracting infection.