Erythropoiesis means formation of red blood cells in the body. Red Blood cells (Erythrocytes) are produced in the bone marrow and its role is to transport oxygen through the blood to the tissues. If red blood cells decrease in body, oxygen carrying capacity of blood will decrease. When oxygen level depletes in the body, kidney releases a hormone called erythropoietin which stimulates bone marrow to produce mature red blood cells. When kidneys are damaged, its ability to release hormone erythropoietin declines. This results in bone marrow not getting signal to produce enough red blood cells resulting in anemia. This is why anaemia is a common phenomenon in people affected with chronic kidney disease. Anemia of CKD usually begins during CKD Stage 3 or 4.
Treatment of Anaemia in CKD
For the treatment of anaemia in CKD patients, synthetically formulated erythropoietin ESA (erythropoiesis-stimulating agent) injections are administered. However, before starting ESA therapy, iron deficiency in the patient has to be examined (measured by Serum Ferritin in blood test). Absolute iron defiency is defined as serum ferritin < 30 ng/mL. In case there is iron deficiency, oral or parenteral iron replenishment doses may be advised by the doctor. Iron helps in production of red blood cells.
Generally, CKD patients are able to tolerate lower levels of haemoglobin* so there is no need to panic if hemoglobin falls below 10g/dl. It is advised to get in touch with your nephrologist immediately in such cases. Normal haemoglobin range is 13.0 for men and 12.0 for women but for CKD patients haemoglobin levels of 9.0 to 11.50 is considered satisfactory.
Erythropoietin injections are costly and doses as advised by doctor should not be skipped. Therefore proper planning for expenses must be done by the patient and their family. While buying EPO injections, one must bring along or buy ice boxes to carry the injections safely and store it in refrigerator safely. Temperature fluctuation while transferring EPO injection from one place to other may alter its properties and effectiveness in treatment of anaemia.
*(Hemoglobin is protein inside red blood cells which carries oxygen)