If your doctor has told you that you have Chronic Kidney Disease (CKD), you may be surprised by the constant feeling of extreme fatigue, the pain you feel when you climb stairs, and the lack of energy to do anything. Many people think that this is part of kidney disease. That is true, but the main cause of many of these symptoms can be a decrease in the amount of blood in your body, which we medically call anemia. What is the connection between the kidneys and a decrease in blood in the body? Today, we will talk about this very simply, in a way that you can understand.
Why do people with kidney disease have low blood counts? Some of the main reasons
Simply put, oxygen is essential for every cell and organ in our body to live and function properly. Our red blood cells carry this precious oxygen from the lungs throughout the body. The protein inside these red blood cells called hemoglobin is what binds to the oxygen.
Now imagine, these vehicles called red blood cells get old and destroyed after a while. Therefore, our body is constantly making new red blood cells to compensate for this deficiency. The factory that makes these red blood cells is our bone marrow. However, the order to "start making red blood cells now" is given to this factory called bone marrow by our kidneys. When they are damaged due to kidney disease, this whole process goes awry. It happens in three main ways.
| The cause of blood loss | To put it simply... |
|---|---|
| Decreased EPO hormone | The kidneys no longer produce the 'signal' that tells the bone marrow to make red blood cells. |
| Shortened lifespan of red blood cells | The red blood cells produced in the body die faster than normal. |
| Nutrient deficiencies | The body lacks the nutrients needed to make red blood cells (iron, vitamin B12, folate). |
Reason 1: Loss of the 'Signal' to make red blood cells
Special cells in our kidneys constantly monitor the oxygen levels in our blood. When the number of red blood cells in our blood decreases and the oxygen levels drop, these cells sense this and release a hormone called erythropoietin (EPO) into the blood. This EPO hormone goes to the bone marrow and tells it, "Okay, let's get to work, make more red blood cells."
When you have chronic kidney disease (CKD), your kidneys gradually become damaged. Because of this damage, your kidneys can't detect low oxygen levels and make the hormone EPO. When EPO is gone, the bone marrow doesn't get the message. So red blood cell production drops dramatically. When new red blood cells can't be produced to keep up with the number that die, the body becomes deficient in red blood cells, or anemia.
Reason 2: Shortened lifespan of red blood cells
Normally, a red blood cell in a healthy person lives for about 120 days . After that, it is destroyed and replaced by a new one.
But due to certain toxins that accumulate in the blood of a person with kidney disease, these red blood cells do not have a proper environment to live in. As a result, their lifespan is reduced to about 70-80 days . That means, instead of waiting for new red blood cells to be produced, the old ones die prematurely. This is another reason that increases anemia.
Reason 3: Lack of iron and nutrients
Iron is the main ingredient needed to make the vehicle called red blood cells. Without iron, hemoglobin cannot be made. Without hemoglobin, oxygen cannot be carried.
We get iron from foods like green leafy vegetables like peas, spinach, and fortified breakfast cereals. But about half of people with severe kidney disease have iron deficiency. There could be several reasons for this.
- Insufficient iron intake from food: Kidney patients may sometimes have to restrict their diet, which may result in a lack of iron-rich foods.
- Reduced iron absorption: Kidney disease can reduce the body's ability to absorb iron from the intestines.
- Blood loss: Frequent blood tests cause the body to lose blood gradually. Also, if someone is undergoing dialysis , the body loses some blood and iron during that process.
In addition to iron, nutrients such as vitamin B12 and folate (Folate/Vitamin B9) are also essential for the proper formation of red blood cells. Some kidney patients are also deficient in these nutrients.
Other things that affect anemia
In addition to these main causes, several other factors can affect the anemia of a kidney patient.
- Frequent infections
- Chronic inflammation in the body: This causes the body to release chemicals called cytokines, which reduce the function of the bone marrow.
- Malnutrition
If you have anemia due to kidney disease, it could be due to one or a combination of these factors. So, it's best not to panic and talk to your doctor to find the exact cause.
Who is at higher risk of anemia?
Not everyone with kidney disease will experience the same amount of anemia, but some people are at higher risk.
- If you are a woman
- If you have diabetes
- If your kidney function is severely reduced or non-functioning
If you have symptoms of anemia (fatigue, weakness, pale skin, dizziness), your doctor may order a complete blood count and tests to check your iron levels. This will determine what treatment you need. There are treatments for this, such as iron pills and injections of the hormone EPO.
Take-Home Message
- There is a close link between chronic kidney disease (CKD) and anemia, which could be the main reason for the fatigue you are feeling.
- The main reason is that damaged kidneys reduce the production of the hormone EPO, which signals them to make red blood cells.
- In addition, rapid destruction of red blood cells and a lack of nutrients like iron and vitamin B12 can also cause anemia.
- If you have symptoms of anemia or suspect you may have it, be sure to talk to your doctor. There are very effective treatments for it.
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