Anemia in kidney disease: why you feel tired and what helps
Dr. Joan J. Morales Lappot, MD3 min read · Leer en español
In briefMany people with kidney disease tell me they feel tired all the time. One common, treatable reason is anemia, a low red blood cell count.
The kidney connection
Your kidneys make a hormone called erythropoietin, or EPO, that tells the bone marrow to make red blood cells. As kidney function falls, especially below an eGFR of about 30, the kidneys make less EPO, and the red blood cell count drifts down. Iron deficiency often adds to the problem.
Signs to notice
- Tiredness and low energy
- Shortness of breath with activity
- Feeling cold
- Pale skin
- Trouble concentrating
- You notice black or bloody stools
- You have chest pain or fainting
- You become short of breath at rest
Treatment
Before anything else, we check iron, vitamin B12, folate and other causes of blood loss. Iron can be given by mouth or by vein. If anemia persists, an EPO-like injection can help the marrow. The goal is not a perfect number: aiming too high with these injections raises the risk of stroke and blood clots, so we aim for a level that helps you feel better safely.