Chronic Kidney Disease (CKD) is the gradual and potentially permanent loss of kidney function. According to the National Kidney Foundation, 37 million adults in the U.S. have CKD with millions more un-diagnosed and at increased risk.
When Chronic Kidney Disease reaches an advanced stage, dangerous levels of fluid, electrolytes and waste can build up in the body. This stage is known as End Stage Renal Disease (ESRD) or kidney failure.
All patients with ESRD will need dialysis or kidney transplantation to sustain life. In the U.S., there are 468,000 patients receiving dialysis. Worldwide, there are nearly 3 million patients on dialysis, and the rate is growing 5-7% annually and projected to reach 5 million by 2025.
Dialysis is a treatment that augments kidney function for patients with failed kidneys by reducing waste and excess fluids. Hemodialysis is the most common form of dialysis, in which patients’ blood is circulated from their body, passed through a filter (dialyzer), and returned to the body during three-times-per-week treatment sessions.
Iron Deficiency Anemia (IDA)
Patients undergoing hemodialysis commonly develop a chronic condition called iron deficiency anemia (IDA) - a condition which is particularly challenging to manage. Hemodialysis patients experience routine loss of blood and circulating iron. This blood loss occurs as part of dialysis treatments because of needle sticks, blood that is trapped in the bloodlines or dialyzer, and frequent blood draws. On average, hemodialysis patients lose 5-7 milligrams of iron at every dialysis treatment. As these iron losses accumulate over time, iron deficiency develops – leading to iron deficiency anemia.
Insufficient Levels of Erythropoietin
Anemia may begin to develop in the early stages of kidney disease, when patients still have 20% to 50% percent of normal kidney function. When kidneys stop functioning properly, insufficient levels of erythropoietin are produced. Erythropoietin is a hormone that stimulates the production of red blood cells in the bone marrow. Insufficient erythropoietin leads to a reduced number of red blood cells available to carry oxygen through the body. Anemia tends to worsen as kidney disease progresses.
The combination of insufficient levels of erythropoietin production and iron deficiency makes it challenging to maintain iron in patients on hemodialysis. Inflammation, build-up of iron stores, and functional iron deficiency can complicate iron management in dialysis patients.
Iron therapies raise the level of iron in the blood. Iron therapies can be taken orally or via injection or delivered through the fluid used in dialysis treatment (dialysate).
Erythropoiesis-stimulating agents (ESAs)
ESAs are medications that work by sending a signal to the body to make more red blood cells. This replaces the function of the erythropoietin hormone that healthy kidneys normally produce.
Red blood cell transfusion
A red blood cell transfusion is a procedure to increase the number of red blood cells in the body by administering red blood cells from someone else’s body through an IV. This can temporarily improve symptoms of anemia.
ESAs and IV iron therapies are widely used, often in combination, to treat anemia and reduce symptoms experienced by dialysis patients.