Treatment Of Anemia In Chronic Kidney Disease
There are a few different ways to treat anemia in chronic kidney disease, including iron supplementation, erythropoietin, red blood cell transfusion and vitamin B12 and folic acid supplements.
Iron: Iron pills can be an effective first step in treating anemia in chronic kidney disease patients. If levels are severely low, iron may be administered intravenously as well.
Erythropoietin: If kidney disease is the cause of anemia which can be confirmed through blood work doctors can use injections to increase EPO. Although injections may aid in kidney function and help treat anemia, they have been linked to cardiovascular events.
Red blood cell transfusion: If red blood cells fall too low, a doctor may prescribe red blood cell transfusion in order to raise red blood cell counts and increase oxygen.
Vitamin B12 and folic acid supplements: Low levels of vitamin B12 as well as folic acid can be contributing factors for anemia, so a doctor may check levels and prescribe supplementation if levels are low.
Signs Of Deficiency And Toxicity
An iron deficiency is seen most commonly in children, women who are menstruating or pregnant, and those eating a diet lacking in iron.
Iron deficiency occurs in stages. The mild form begins with a decrease in stored iron, usually either from a low-iron diet or from excessive bleeding. If this does not resolve, the next stage is a greater depletion of iron stores and a drop in red blood cells. Eventually this leads to iron-deficiency anemia where iron stores are used up and there is significant loss of total red blood cells. Typically, a doctor screens for anemia by first checking a complete blood count . If this is below normal, ferritin and transferrin levels may be measured to determine if the type of anemia is IDA . All of these measures would decrease with IDA.
Signs of IDA:
- Hair loss, brittle nails
- Pica: cravings for dirt, clay, ice, or other non-food items
IDA is usually corrected with oral iron supplements of up to 150-200 mg of elemental iron daily. Those at high risk of IDA may be prescribed 60-100 mg daily. Blood levels should be rechecked periodically, and supplements discontinued or taken at a lower dosage if levels return to normal, as long-term high dosages can lead to constipation or other digestive upset.
Groups at risk for IDA:
- Nausea, vomiting
- Abdominal pain
What Is The Link Between Ckd And Anemia
People with CKD are at an increased risk for anemia because theyre unable to produce the hormone erythropoietin that stimulates production of red blood cells.
People with CKD also tend to experience blood loss and have difficulty absorbing iron from their gut. In addition, those with advanced CKD who require hemodialysis also lose blood during their dialysis treatment.
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Megadosing Vitamin C May Injure Kidneys
The megavitamin movement of the 1970s suggested that taking large doses of common vitamins would benefit health. Unfortunately, the alleged benefits may come at a price. A November 2017 update in GeneReviews states that megadosing vitamin C may lead to kidney failure. Surprisingly, even juicing with certain fruits and vegetables may cause this damage.
Many Americans use nutritional supplements to improve their health. As with vitamins, using these dietary aids increases the risk of organ damage. In fact, 1 in 12 people in the U.S. take supplements known to cause kidney damage, according to a March 15 report in the American Journal of Public Health.
Despite these risks, the Food and Drug Administration continues to leave nutritional supplements unregulated. Thus, people must take the initiative and educate themselves about the potential benefits and risks of dietary aids.
A September 2017 review in Food and Chemical Toxicology offers a starting point. This article provides a brief summary of kidney-damaging supplements. The authors suggest avoiding such dietary aids and specifically recommend avoiding excess doses of vitamins A, C and D.
What Do You Need To Know
What are the side effects of iron supplements and why do you need to know? These questions will be answered here.
The most critical side effect is death in children who accidentally overdose on iron containing products. This is the leading cause of poisoning death in children under 6 years of age.
Should accidental ingestion happen, get immediate medical attention or call your poison control center.
Common Side Effects of Supplementing with Iron
Note: These may be the result of using iron supplements. They may or may not happen. Everyone is different and the results are different too.
- stomach cramps
- stools may turn black or green in color
Note: if black sticky stools with or with out red streaks, cramping, soreness, sharp pains in the stomach or abdomen are present, you should immediately see a doctor or go to the Emergency Room to get further evaluated.
Less Common But Possible Side Effects
- abdominal or stomach pain
- contact irritation
Serious Side Effects
The serious side effects of iron supplementation are only part of the Iron Supplements Risks. If you have any of these symptoms you will need to speak to your doctor immediately.
- severe stomach pains
- other symptoms not listed above that start after taking iron supplements
These are the most common bad side effects of iron supplements.
Side Effect Risk verses Benefit Conditions
One Major Side Effect Benefit…
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Iron Supplements & Liver Damage
The body needs to make red blood cells, among other functions. Most people get enough iron through their diet, but some people require iron supplements to achieve adequate levels of iron. Too little iron stored in the body may have serious consequences; too much iron in the body can also be dangerous and cause damage to organs, especially the liver.
Understand How To Prevent Kidney Stones
The National Kidney Foundation offers a helpful backgrounder on diet and kidney stones, which are formed when crystals accumulate in the urine. The foundation offers some tips to help prevent the formation of kidney stones. They include:
- Drink water. Staying hydrated is one of the best measures you can take to avoid kidney stones. Drink at least 12 cups of fluid daily.;
- Talk with your health care provider about your diet. Sometimes, she will recommend a special diet or medication.
- Reducing your intake of animal protein, such as beef, poultry, fish, eggs and cheese, may help.
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When Will I Start To Feel Better
When you should start to feel better depends on your particular situation. Normally, it may take from a week to a month before you start to feel better. Continue to watch your symptoms and take note of side effects that might be caused by the supplements. If you have any questions or concerns, talk to your healthcare provider.
Injection Therapy Treatment For Iron Deficiency Anemia In Ckd
For patients with kidney-related illnesses like chronic kidney disease , anemia is a common problem. Anemia occurs when the body does not produce enough red blood cells, which are responsible for carrying oxygen to your heart, brain, and other tissues and organs. Low red blood cell counts can lead to various bodily malfunctions. While there is no cure for CKD, injection treatments can help slow the progression of the disease and treat complications like iron deficiency anemia.
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Meeting Reportiron Management In Chronic Kidney Disease: Conclusions From A Kidney Disease: Improving Global Outcomes Controversies Conference
Before the introduction of erythropoiesis-stimulating agents in 1989, repeated transfusions given to patients with end-stage renal disease caused iron overload, and the need for supplemental iron was rare. However, with the widespread introduction of ESAs, it was recognized that supplemental iron was necessary to optimize hemoglobin response and allow reduction of the;ESA dose for economic reasons and recent concerns about ESA safety. Iron supplementation was also found to be;more efficacious via intravenous compared to oral administration, and the use of intravenous iron has escalated in;recent years. The safety of various iron compounds has been of theoretical concern due to their potential to induce iron overload, oxidative stress, hypersensitivity reactions, and a permissive environment for;infectious processes. Therefore, an expert group was convened to assess the benefits and risks of parenteral iron, and to provide strategies for its optimal use while mitigating the risk for acute reactions and other adverse effects.
- Previous article in issue
Can I Take Iron Supplements For Ckd
If your blood work shows that you have iron deficiency, your doctor will prescribe a trial of iron supplements either through pills or injection.
Iron pills are inexpensive and easy to take, but theyre limited by gastrointestinal side effects and poor absorption.
If iron pills fail to improve your hemoglobin levels, your doctor might prescribe iron through an injection.
Iron injections are safe and well tolerated. Some older forms of iron injection came with an increased risk for allergic reactions. But this happens very rarely with the newer forms currently used.
If youre already on dialysis, youre usually prescribed iron through an injection. In fact, more than half of those on hemodialysis require regular iron injections.
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Avoid Iron Supplements If You Have These Conditions
If you have any of the following conditions, avoid iron supplements as they may increase your risk of iron toxicity.
Hemochromatosis is a genetically inherited disease that can cause iron to accumulate to toxic levels in the body. Without treatment, this disease can lead to problems like liver cancer, liver cirrhosis, and heart disease. People with this condition should not use iron supplements or vitamin C supplements, which increase iron absorption.
African Iron Overload
First observed among the people of African descent, this is a rare condition caused due to the high intake of dietary iron. The condition is believed to result from the consumption of a;traditional African beer, which contains;dissolved iron from;metal drums in which it is brewed. People with this condition should avoid taking iron supplements.
The excess iron accumulates in the immune cells in the;bone marrow and spleen and compromises the infection-fighting ability of the immune system. As the condition progresses, iron also accumulates in the liver cells, causing toxicity, liver disease, and even cancer.12
How Is Anemia Treated In Ckd
If iron supplements dont sufficiently increase your hemoglobin levels, your doctor will prescribe injectable hormones to stimulate red blood cell production. That includes drugs such as darbepoetin and epoetin.
These therapies are generally not started until the hemoglobin falls below 10 grams per deciliter . Most people with CKD are given these injections under their skin. If youre receiving hemodialysis, these drugs are administered during dialysis treatment.
Iron supplementation is continued during treatment with these hormones.
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How Does Chronic Kidney Disease 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:
Are older than 75 years
Iron Therapy After Kidney Transplantation
Anemia is observed in 2139.7% of adult renal transplant patients . The prevalence may be even higher in pediatric transplant recipients: 84.3% of children were anemic in the first month after kidney transplantation, and prevalence of anemia was not below 64.2% between 6;months and 6;years after transplantation. Iron deficiency was identified in 2756% of children between 1 and 60;months posttransplantation . Fourteen pediatric and young adult renal transplant recipients received single iron gluconate infusions ranging from 1.9 to 6.4;mg/kg. The mean hemoglobin level increased significantly from 10.1±1.6 to 11.4±2.1;g/dl following ferric gluconate therapy. Adverse events were observed in three children . A recent study by Morii and coworkers showed that oral coadministration of ferrous sulphate markedly decreased the absorption of mycophenolate mofetil in healthy Japanese subjects . However, a randomized crossover trial failed to confirm this observation in European transplant patients receiving long-term mycophenolate mofetil therapy . In line with this observation, an in vitro study showed that iron ions did not interact with mycophenolate mofetil .
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Primary Hemochromatosis: A Genetic Mutation
Hereditary hemochromatosis, which people may also refer to as primary or classic hemochromatosis, is one of the most common genetic conditions in the United States. Not everyone with the condition experiences symptoms.
This condition mostly affects white people. According to a 2018 study , about 1 in 200 Caucasian people in the United States and Australia have hereditary hemochromatosis, and 1014% of each of these populations carry the genetic mutations.
Hereditary hemochromatosis occurs due to a mutation in a gene called HFE. This gene controls the amount of iron that the body absorbs. Two possible mutations in the HFE gene are C282Y and H63D.
In the U.S., most people with inherited hemochromatosis have inherited two copies of C282Y, one from the mother and the other from the father. A person who inherits just one faulty gene is not certain to develop iron overload syndrome, but they will be a carrier, and they will probably absorb more iron than normal.
If both parents are carriers, there is a 1 in 4 chance that their child will have two faulty genes, one from each parent. However, some people with two copies of the C282Y mutation never experience symptoms.
Some people inherit one C282Y mutation and one H63D mutation. A small proportion of these people will develop hemochromatosis symptoms. Inheriting two copies of H63D is rare, and research has not yet confirmed whether this may increase the risk of hemochromatosis.
Anemia Iron Deficiency Linked To Chronic Kidney Disease
Written byEmily LunardoPublished onNovember 2, 2015
Anemia, a condition caused by iron deficiency, has been linked to chronic kidney disease. When the body does not produce enough red blood cells it can lead to anemia. Red blood cells are the cells that carry oxygen around the body. When there is a shortage of red blood cells it means fewer cells can convert glucose from food into energy, thus causing feelings of fatigue, weakness and overall tiredness because the body does not have enough energy to perform its many tasks.
To treat anemia iron supplements are often prescribed, along with a diet of iron-rich foods like red meat or kale. If anemia goes untreated, then major organs, such as our heart and brain, can become affected. Research also shows that it is linked to chronic kidney disease as well.
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Diet And Nutrition For People With Chronic Kidney Disease
Its important to eat a healthy diet if you have been diagnosed with chronic kidney disease as many foods can harm your kidneys. For example, red meat is very harsh on your kidneys so you will want to minimize or remove it from your diet. Due to red meat containing high amounts of iron, though, you will need to look for plant-based sources of iron to compensate and avoid anemia, such as kale or spinach.
Here are some other tips for diet and nutrition to keep in mind if you have chronic kidney disease.
- Prepare and choose foods with reduced salt.
- Consume the right protein as mentioned, red meat can be harmful, so stick with fish, eggs, chicken and plant-based proteins instead.
- Choose heart-healthy foods like beans, whole grains, fruits and vegetables.
- Choose foods with less phosphorus, such as fruits, vegetables and rice products, and avoid items like dairy and soda.
- Choose foods with a good amount of potassium, such as apples, carrots and white rice foods like bananas have too much potassium.
- Drink plenty of water.
- Cut out sugary drinks like soda or juice.
- Drink alcohol in small amounts and sparingly.
Following these tips can help you with your chronic kidney disease and still provide you with food options that contain iron to reduce your risk of anemia.
How Common Are Anemia And Iron Deficiency In Ckd
Anemia occurs when your red blood cells are in short supply. It can lead to symptoms such as fatigue.
Anemia is a common problem in people with chronic kidney disease . Anemia becomes more common with increasing severity of CKD. It occurs in less than one in five people with mild CKD, but almost two-thirds of those with advanced CKD experience anemia.
Anemia is easily diagnosed using a blood test that measures hemoglobin. If you have mild CKD, you should have your blood screened for anemia every year. Your blood work should be checked more frequently if you have advanced CKD or if youve already been diagnosed with anemia.
After an anemia diagnosis, your doctor should perform a thorough evaluation to identify whats causing it. This includes a complete blood count, studies of iron levels, and other tests, depending on the clinical situation.
Iron deficiency is a common and treatable cause of anemia in CKD. About half of those with CKD have low iron levels on their blood tests. People with CKD also require slightly higher iron levels to make red blood cells.
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Iron And Cardiovascular Risk
In vitro experiments have demonstrated that iron treatment results in a dose-dependent increase in the expression of adhesion molecules in human aortic endothelial cells, accompanied by enhanced mononuclear cell adhesion to the endothelial cells . In 5/6 nephrectomized rats, intravenous iron induced oxidative stress in cardiovascular tissues . A recent experimental study has furthered our understanding of how iron is involved in atherogenesis in CKD . By conducting both in vitro and in vivo experiments, Kuo et al. demonstrated that iron treatment increased mononuclear-endothelial cell adhesion through NADPH oxidase/NF-/cell-adhesion molecule signaling, thus exacerbating atherosclerosis. These results are in line with previous observations that cumulative iron doses are positively related to carotid intima media thickness in hemodialysis patients . Recent observational studies have also demonstrated that intravenous iron administration of 50 mg per week or >800 mg within 6 months is associated with a significantly increased risk of cardiovascular events. However, it should be noted that, as these studies were observational, causality could not be shown because of the remaining confounding factors. In contrast, another observational study of hemodialysis patients in the United States found an association between intravenous iron treatment and significantly better survival .