Anemia of chronic disease and kidney failure

Anemia happens when there are not enough red blood cells to carry oxygen throughout the body. Anemia also occurs from many causes due to decreasing the number of red blood cells or too few red blood cells (Mayo Clinic, 2020). The most common type of anemia is iron deficiency (Mayo Clinic, 2020). The normal process of making red blood cells are from the bone marrow. Bone marrow produces pluripotent stem cells that can differentiate into any variety of blood cells, including red blood cell (RBC), white blood cell (WBC), and platelet (McCance & Huether, 2019). The kidney releases a hormone called erythropoietin (EPO), which response to a stimulus such as hypoxia and functions in the pathway’s steps to affect red blood cell production and hemoglobin synthesis (McCance & Huether, 2019). In the last stage of maturation, red blood cell division is complete, and hemoglobin synthesis becomes the primary intracellular process (McCance & Huether, 2019).

Understanding the structure of hemoglobin which can help to define the types of anemia that the patients have. First, the hemoglobin structure is a four-chain protein synthesized in a separated process during the reticulocyte stage (McCance & Huether, 2019). It consists of four chains, two alpha, and two beta. Hemoglobin synthesis has two primary components, including the synthesis of heme and globin synthesis (McCance & Huether, 2019). The synthesis of heme goes through a series of chemical reactions culminating between succinyl CoA and iron (McCance & Huether, 2019). When heme has a low level of iron deficiency, there is a low level of hemoglobin, which is caused by chronic kidney disease. As a result, anemia can occur from several processes: impaired red blood cell division, impaired hemoglobin synthesis, and premature destruction of mature cells (McCance & Huether, 2019). When evaluating an anemic patient, it is important to distinguish whether RBC synthesis or hemoglobin synthesis (McCance & Huether, 2019).

When kidney damage or patients is suffering from chronic kidney diseases, there are low levels of erythropoietin which led to low levels of red blood cell counts and cause anemia (Hormone Health Network, 2020). The study of Colbelt (2020) also stated that patients with advanced stages of chronic kidney disease usually had decreased RBC production due to a lack of erythropoietin and iron deficiency. The most common cause of anemia of chronic disease is microcytic hypochromic anemia (Braden, 2020). Microcytic hypochromic anemia is decreased heme production results in reduced globin production that leads to a deficiency of hemoglobin synthesis (McCance & Huether, 2019). Therefore, patients with renal disease are related to anemia conditions and must have proper treatment to reduce complications.

Patients with chronic kidney disease usually feel weakness, fatigue, dizziness, difficult breathing or shortness of breath, chest pain, and paleness (National Institute of Diabetes and Digestive and Kidney Diseases, 2020). Clinicians can base medical history, physical exam, and blood tests to diagnose patients with anemia in chronic kidney disease (National Institute of Diabetes and Digestive and Kidney Diseases, 2020). There are several ways to treat anemia with chronic kidney diseases such as iron supplements, erythropoietin injection, red blood cell transfusion, vitamin B12, and folic acid supplements (National Institute of Diabetes and Digestive and Kidney Diseases, 2020).







Braden, C. (2020). Chronic anemia. Medscape. Retrieved from:

Colbelt, G. (2020). Anemia of chronic disease and kidney failure. Medscape. Retrieved from:

Hormone Health Network. (2020). What is erythropoietin? Retrieved from:

Mayo Clinic. (2020). Anemia. Retrieved from:

McCance, K.L., & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MI: Elsevier.

National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Anemia in chronic kidney disease. Retrieved from:

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