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?

Anemia happens when there are not enough 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.

  • Normal

    The oxygen that we breathe in passes through our lungs and into the red blood cells.

  • Anemia

    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.

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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, and 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 diabetes

  • Have heart disease

  • Have high blood pressure

  • Are African-American

  • Are older than 75 years

If you think you might be at risk, talk to your doctor about getting tested. Management of anemia and its symptoms may help you feel better.

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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.

  • Pale skin

    Paleness is caused by reduced blood flow or a lower number of red blood cells.

  • Chest pain

    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

  • Cold intolerence

    Sensitivity to the cold may mean there is not enough oxygen being delivered in the blood to your body

Take our short quiz to learn more about the symptoms of anemia.

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Causes of anemia in CKD

There are two main causes of anemia in CKD:

CKD and erythropoietin

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.

Healthy kidney:

  • Healthy kidney

  • Normal EPO

  • Normal number of red blood cells


  • Chronic Kidney Disease

  • Reduced EPO

  • Reduced number of red blood cells

CKD and iron

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 kinds of anemia

There are several kinds of anemia. Anemia caused by having too little EPO or too little iron in your body are the most common in people with CKD. Talk to your doctor to learn more.

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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.

Take our short quiz to learn more about the symptoms of anemia.

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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 medicines that work by sending a signal to the your body to make more red blood cells.
  • Iron supplements — 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 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.


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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.

Click here to download a copy of the Anemia in ESRD booklet.

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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.

Online courses with free CEs for professionals

Talk to your patient guide

View the doctor conversation guide video

Gain insights from our kidney disease and anemia survey

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