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
Sources:
- 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
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