Patients on dialysis:

The majority of patients on dialysis have anemia. Anemia in dialysis patients is caused by having:

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 your body to make more red blood cells. If your kidneys are not working as well as they should or have stopped working, they cannot make enough EPO. Without enough EPO, your body does not 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


  • End-stage renal disease

  • Reduced EPO

  • Reduced number of red blood cells

Less iron than normal

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 ESRD 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. It can also be caused by losing blood, because iron is stored in your red blood cells.

Iron deficiency is more common in people on dialysis. This happens from:

  • Not eating enough foods that are rich in iron

    Certain iron-rich foods like red meats and beans may be limited in a dialysis diet. If you do not eat enough iron, you may not have as much iron as you need.

  • Blood loss during dialysis

    After a hemodialysis session, a small amount of blood is often left in the dialyzer (dialysis machine). Over time, this amount lost will build up and could lead to not having enough iron.

  • Frequent blood draws

    Patients with kidney failure may need to have blood tests more often than a healthy person, which can increase the risk of not having enough iron.

Patients who have had a kidney transplant:

Patients who have had a kidney transplant are at higher risk for having anemia. Anemia in kidney transplant patients is caused by having:

Less erythropoietin (EPO) than normal

If you have a kidney transplant, sometimes the new kidney does not work as well as a kidney in a healthy person. If your new kidney is not working as well as it should, it cannot make enough of the EPO hormone, which leads to anemia.

Less iron than normal

When you have a kidney transplant, you lose blood during the kidney transplant surgery. You will also have blood tests often to check on the health of your new kidney. Blood loss from the surgery and from frequent blood draws increases your risk of not having enough iron, and getting anemia.

Immunosuppressant (anti-rejection) medicines

If you have a kidney transplant, you are required to take medicines that decrease your immune system, called immunosuppressants. These medicines keep your body from attacking the new kidney. Immunosuppressant medicines can have many side effects, including causing anemia.

The risk of anemia after kidney transplant is higher right after the transplant surgery. This is because the new kidney takes some time before it starts making enough EPO, and because a patient’s iron levels are low from losing blood. Over time, the risk for anemia decreases in patients who have had a kidney transplant, as long as their new kidney stays healthy.

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 ESRD. Talk to your doctor to learn more.