Are you at risk for anemia?
Take our short quiz to learn more about the symptoms of anemia.
There's more to chronic kidney disease than you think...
If your kidneys are not working properly, they may not be able to help your body make the red blood cells it needs. Anemia is a common side effect of kidney disease.
- What causes anemia?
- How does chronic kidney disease (CKD) cause anemia?
- What are the symptoms of anemia?
- What type of anemia is common in people with CKD?
- How will I know if I have anemia?
- How is anemia treated?
- Anemia and end-stage renal disease (ESRD)
- Talk with your doctor about anemia
- Resources for professionals
- Resources for patients
- Common questions about anemia in kidney disease
What causes anemia?
Anemia happens when there are not enough healthy red blood cells in your body.
Red blood cells carry oxygen through your bloodstream, giving you energy and helping your muscles, bones, and organs work properly.
The oxygen that we breathe in passes through our lungs and into the red blood cells.
In anemia, there are not enough red blood cells to carry this oxygen around the body.
Anemia can make you feel weak and tired because you are not getting the energy you need.
How does chronic kidney disease (CKD) cause anemia?
Anybody can develop anemia, but it is very common in people with CKD. People with CKD may start to have anemia in the early stages of CKD, but it is most common in stages 3-5. Anemia usually gets worse as CKD gets worse. If your kidneys are not working as well as they should, you are more likely to get anemia.
Anemia in CKD is more common if you:
Have heart disease
Have high blood pressure
Are older than 75 years
If you think you might have CKD, talk to your doctor about getting tested. Management of anemia and its symptoms may help you feel better.
What are the symptoms of anemia?
Anemia can happen with or without symptoms. Many of the symptoms of anemia can also be caused by other problems. The only way be sure if you have anemia is to get tested. If you are experiencing symptoms, it is important that you talk to your doctor.
Dizziness, loss of concentration
Feeling dizzy or having difficulty concentrating may be a sign that your brain is not getting enough oxygen.
Paleness is caused by reduced blood flow or a lower number of red blood cells.
Anemia in CKD can increase your risk of heart problems because the heart has to work harder to provide blood to your body. If you experience an unusually fast heart rate or are worried about your heart health, please speak to your doctor.
Shortness of breath
Your blood may not have enough red blood cells to deliver oxygen to your muscles. By increasing your breathing rate, your body is trying to bring more oxygen into your body.
Fatigue or weakness
Easy fatigue, loss of energy, and reduced physical capacity
Sensitivity to the cold may mean there is not enough oxygen being delivered in the blood to your body
What type of anemia is common in people with CKD?
There are two main causes of anemia in CKD:
Less erythropoietin (EPO) than normal
All of the cells in your body live for a certain amount of time and then die. Your body is always working to make new cells to replace the ones that have died. Red blood cells live for about 115 days. Your kidneys help your body make red blood cells.
Healthy kidneys make a hormone called erythropoietin (EPO). EPO sends a signal to the body to make more red blood cells. If your kidneys are not working as well as they should, they can’t make enough EPO. Without enough EPO, your body doesn’t know to make enough red blood cells. This means fewer red blood cells are available for carrying oxygen through your body, leading to anemia.
Normal number of red blood cells
Chronic Kidney Disease
Reduced number of red blood cells
Iron is a mineral found in many foods, such as meats and leafy greens. Your body uses iron to make red blood cells. A common cause of anemia in people with CKD is iron deficiency. Iron deficiency means you do not have enough iron in your body. It can be caused by not getting enough iron in your diet or by losing blood, either through blood tests or during dialysis. If you don’t take in enough iron through your diet, you can get anemia. Around half of people with CKD stages 2 to 5 have some kind of iron deficiency.
Causes of iron deficiency
Not eating enough foods that are rich in iron
Iron from your food is not being absorbed properly into your bloodstream
Frequent blood donation or testing may increase demand for iron
Blood loss from dialysis
Other types of anemia
Anemia caused by having too little EPO or too little iron in your body are the most common in people with CKD. However, there are also other types of anemia. Talk to your doctor to learn more.
How will I know if I have anemia?
Talk to your doctor if you think you may have anemia. The only way to know if you have anemia is to have a blood test. When you have kidney disease, your doctor will want you to have blood tests often. These tests are used to check not only your kidney function, but also for signs of any other problems, such as the number of red blood cells and how much iron you have in your body.
The test for anemia is a simple blood test to check for the amount of hemoglobin in your blood. Hemoglobin is a part of your red blood cells. Figuring out the amount of hemoglobin you have in your blood can tell your doctor how many red blood cells you have.
Your doctor may also ask you if you’ve noticed any symptoms, such as changes in skin color or feeling unusually tired.
How is anemia treated?
Getting your anemia treated can help you feel better. Depending on the cause of your anemia, your doctor may recommend one of the following treatments:
- Erythropoiesis-stimulating agents (ESAs) — ESAs are injectable medicines that work by sending a signal to the your body to make more red blood cells.
- Iron supplementation — Your doctor may give you iron supplements as pills or as a shot. If you are on dialysis, you may be given an iron supplement during your dialysis treatment.
- Red blood cell transfusion — A red blood cell transfusion is a procedure to increase the number of red blood cells in your body by giving you red blood cells from someone else’s body through an IV. This can temporarily improve your anemia symptoms.
Doctors and researchers are working on potential new treatments for anemia. New treatments in development are tested in clinical trials. If you’re interested in joining a clinical trial to try an investigational new treatment for anemia, visit ClinicalTrials.gov to learn about all available clinical trials for anemia.
If you have CKD, getting early treatment for your anemia can help slow the progress of your CKD. If you think you might have anemia, talk to your doctor about getting tested.
Anemia and end-stage renal disease (ESRD)
Anemia and end-stage renal disease (ESRD), also known as kidney failure, often go hand in hand. Most people with kidney failure who are on dialysis have anemia. Kidney transplant patients are also at higher risk for anemia. Learn more.
Talk with your doctor about anemia
Talk with your doctor or another member of your health care team to find out more about your anemia symptoms and treatment options. Our Talk to Your Doctor Guide can help you get the conversation started.
To get your guide, click "Get started" and just fill out our quick 7-question symptom survey.
Note: This survey is not a medical diagnosis. This guide is an awareness tool designed for you and your doctor to use together. The information you provide is anonymous and will not shared.
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Download your printable Doctor Conversation Guide. Remember to show it to your doctor!
Note: Some mobile device settings will not allow for the PDF to download properly.
If you are having trouble, please visit this page on a desktop computer for access to the PDF.
Learn more about anemia and chronic kidney disease and receive updates from the American Kidney Fund.
Resources for professionals
The ACT on Anemia campaign is helping health care professionals have conversations with their patients about the link between chronic kidney disease and anemia.
Resources for patients
Download the tools you need to learn more about the connection between chronic kidney disease and anemia. Use these materials to start a conversation during your next health care appointment.
Common questions about anemia in kidney disease
How are patients with kidney disease and anemia treated?
Iron supplements, erythropoiesis-stimulating agents (ESAs) and red blood cell transfusions are current treatment options for anemia in chronic kidney disease (CKD). Doctors and researchers are working on potential new treatments for anemia that can be administered orally (by mouth) and may provide another option for treatment.
Can kidney disease cause anemia?
Anemia is more common in people with chronic kidney disease (CKD) and it can be caused by your CKD. Anemia happens when there are not enough red blood cells in your body. When your kidneys are not working like they should, your body may produce fewer red blood cells. Also, people with anemia and chronic kidney disease have lower levels of iron which is also used to make red blood cells. Fewer red blood cells means less oxygen is carried to your organs and tissues. Learn more.
What type of anemia is associated with chronic kidney disease?
There are several kinds of anemia. The most common types of anemia in people with chronic kidney disease (CKD) are anemia caused by having too little of a hormone called erythropoietin (EPO) and anemia caused by having too little iron in your body. Learn more.
Is anemia a sign of kidney disease?
No, having anemia does not always mean you have kidney disease. However, anemia is a common complication of kidney disease. Anemia happens when there are not enough red blood cells in your body. If your kidneys are not working properly, they may not be able to help your body make the red blood cells it needs. Learn more.
Does anemia cause kidney disease?
No, anemia does not cause kidney disease. Anemia is a complication of CKD. People with CKD may start to have anemia in the early stages of CKD, though it is most common in people with stages 3-5 CKD. Anemia usually gets worse as your kidney function gets worse.
Can low iron affect kidneys?
People with anemia and chronic kidney disease (CKD) may have lower levels of iron which is used to make red blood cells. This can be caused by not getting enough iron in your diet or by losing blood, either through blood tests or during dialysis. Fewer red blood cells means less oxygen is carried to your organs and tissues. Learn more.
What are some of the signs and symptoms of anemia in chronic kidney disease patients?
Anemia can happen with or without symptoms. Many of the symptoms of anemia can also be caused by other problems. The only way be sure if you have anemia is to get tested by your doctor. Signs or symptoms of anemia include:
- Loss of concentration
- Pale skin
- Chest pain
- Shortness of breath
- Fatigue or weakness
- Sensitivity to cold
Are there foods you can eat to help with anemia when you have chronic kidney disease?
If your body does not have enough iron, a dietitian or health care professional may recommend you add more foods with iron to your diet. Foods high in iron include: shellfish, spinach, red meat, beans and broccoli. However, some of these foods may be high in other nutrients, like sodium, phosphorus, or potassium, which people with chronic kidney disease (CKD) may need to limit. Talk with your health care team before making changes to your diet. Learn more about eating healthy with kidney disease.