Kidney failure is characterized by a complete loss of kidney function. Hemodialysis is the most common treatment method for permanent kidney failure. During hemodialysis, a machine is used to filter wastes, extra fluid and salts from your blood. Anemia, which is characterized by a low red blood cell count, often develops as a complication of kidney failure and hemodialysis.
Physiology
Healthy kidneys produce a hormone called erythropoietin, or EPO. When the level of oxygen in your body decreases, the production of EPO increases, stimulating the stem cells in your bone marrow to produce more red blood cells. Approximately 90 percent of the EPO in your body is made in your kidneys. When you have kidney failure, the amount of EPO in your body decreases drastically. This combination of decreased levels of EPO and blood loss from hemodialysis often leads to anemia.
Development of Anemia
Anemia generally begins to develop in the early stages of kidney disease, when 20 to 50 percent of kidney function remains. As kidney disease progresses, your body's ability to make red blood cells decreases exponentially, and anemia worsens. According to the National Kidney and Urologic Diseases Information Clearinghouse, almost everyone with end-stage kidney failure, which is characterized by kidney function of less than 10 percent and the need for hemodialysis, has anemia.
Treatment
A common treatment for anemia caused by hemodialysis is administration of a synthetic form of EPO. This synthetic EPO is injected directly under the skin two to three times per week, depending on your specific condition. The National Kidney and Urologic Diseases Information Clearinghouse notes that people on hemodialysis that cannot tolerate EPO usually receive EPO intravenously during hemodialysis treatment. In addition to EPO injections, some patients with anemia also receive iron. Iron allows your body to make hemoglobin, the protein center of your red blood cells. Without iron, your body cannot make healthy red blood cells. Iron may be given orally or administered intravenously, although the intravenous method is more effective.
Considerations
Patients on hemodialysis should have a hematocrit level between 10 and 12 g/dL. The hematocrit represents the percentage of blood that is made up of red blood cells. A hematocrit level of more than 12 g/dL increases a hemodiaylsis patient's risk of heart attack, stroke and heart failure. Because of this, it is important to have your doctor monitor your hematocrit levels regularly if you are on hemodiaylsis and receiving EPO injections.
