Let's Get to Know Iron Deficiency Anemia in Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a condition where kidney function decreases drastically. The most common complication in CKD patients is anemia and is associated with a decrease in the patient's quality of life. Anemia is characterized by a decrease in Hb (hemoglobin), which is an iron protein found in red blood cells and used by the body to transport oxygen.

The main cause of anemia in CKD is a relative deficiency of the hormone erythropoietin, but many other factors play a role in anemia in CKD, namely reduced lifespan of red blood cells due to uremic toxicity, blood loss through the gastrointestinal tract, iron deficiency, folate deficiency, severe hyperparathyroidism, inflammation and infection.

Iron deficiency is the second most common cause of anemia in CKD patients undergoing hemodialysis. Iron deficiency anemia in CKD patients is mainly caused by inadequate nutritional intake, impaired absorption, chronic bleeding, inflammation or infection, and increased iron requirements during anemia correction with Erythropoietin Stimulating Agent (ESA) therapy.

CKD patients who have had symptoms of anemia before will undergo a series of tests aimed at establishing the cause of their anemia. If anemia is found, proceed with examination of the Complete Blood Count, peripheral blood smear, reticulocyte count, fecal occult blood test, examination of serum iron levels (serum iron/SI), total iron binding capacity (TIBC), transferrin saturation (ST), and ferritin serum.

After the cause of anemia in CKD is confirmed as a result of iron deficiency, the patient will undergo a series of iron therapy according to the severity of the deficiency, which can be in the form of oral or intravenous iron therapy.
Medical nutritional therapy in CKD patients refers to the patient's needs on a personalized basis, depending on the stage of the disease and its complications. CKD patients may need to change what they eat to manage anemia and CKD. In patients who have a confirmed deficiency of iron, vitamin B12, or folate, it may be recommended that the patient add more foods with these nutrients to their daily diet. However, some of the food sources of these nutrients have high amounts of protein, sodium, or phosphorus, which may need to be limited in patients with CKD. Therefore, it is important for Hermina's friends to consult with a clinical nutrition specialist to get assistance regarding appropriate personalized medical nutrition therapy.

Reference :
1.Kandarini Y. Management of Anemia in Chronic Kidney Disease.
2.Besarab A, Yee J. Treatment of anemia in patients with end-stage renal disease. In: Henrich WL (ed). Principles and Practice of Dialysis. Philadelphia: Lippinkott William and Wilkins 2009;499-523
3. Singh AK. Anemia of Chronic Kidney Disease. Clin J Am Soc Nephrol. 2008;3:3-6.
4.KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl 2012: 283-308.