What are the causes of anemia in CKD?

Causes of anaemia in CKD:

Anaemia in CKD impairs quality of life and well-being. A normochromic, normocytic anaemia develops due to a number of causes:

  • Erythropoietin deficiency (most significant)
  • Diminished erythropoiesis due to toxic effects of uremia on bone marrow precursor cells
  • Reduced dietary intake, absorption and utilization of haematinics (iron, vitamin B12, folic acid)
  • Increased red cell destruction (may also be during hemodialysis due to mechanical, oxidant and thermal damage). RBCs have a shortened lifespan in uraemia.
  • Increased blood loss due to capillary fragility, poor platelet function, occult gastrointestinal bleeding and blood loss during hemodialysis
  • Erythropoietin alpha therapy may cause anaemia (by pure red cell aplasia)
  • ACE inhibitors may cause anaemia in CKD, probably by interfering with the control of endogenous erythropoietin release.
  • Secondary hyperparathyroidism (leads to bone marrow fibrosis)

Additional: Markers of iron status and the recommended target ranges in CKD

Markers of iron status and the recommended target ranges in CKD


  • Kumar & Clark’s Clinical Medicine 9e (2016); page: 778
  • Long cases in clinical medicine by ABM Abdullah; page: 389
  • Davidsons Principles and Practice of Medicine 23 edition; page: 419

Post a Comment