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What Is the Treatment for Renal Anemia?

By Jillian O Keeffe
Updated May 17, 2024
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Anemia refers to a deficiency in red blood cells. A hormone produced in the kidneys promote the production of red blood cells, and damage to the kidneys can lead to this condition. Replacement of the hormone with artificial hormone is one treatment that can help control renal anemia. Iron supplements are potentially helpful to some patients, as can folic acid and Vitamin B12 supplements.

The kidneys primarily filter waste liquids from the body and turn it into urine for the body to expel. In addition to this role, the kidneys also produce a hormone called erythropoietin (EPO). This chemical is a signal to the body to make more red blood cells. A healthy person's blood contains a significant proportion of red blood cells, which are the cells that carry oxygen around the body. To do their job, red blood cells also need a lot of iron as part of their hemoglobin group, which is the specific molecule inside the cells that carry the oxygen.

When one or more kidneys are damaged, the production of EPO can go down. Red blood cells are manufactured in the bone marrow, in response to signals of EPO from the kidneys. With little EPO, the cell production slows down. Lack of sufficient oxygen carriers in the bloodstream can result in symptoms like paleness, weakness and may also affect the heart.

In addition to low EPO levels, renal anemia can also be caused by loss of blood during dialysis. Dialysis is a procedure that removes blood from the body, extracts the waste material to replace a normal kidney function, and then replaces the cleaned blood back into the body. Blood can be lost during this process by getting caught up in membranes or from becoming damaged during the dialysis session. Vitamins like folic acid can also be lost during dialysis.

Traditionally, renal anemia was treated with red blood cells from a donor and testosterone supplements. Testosterone had a small effect on blood cell production in the bone marrow, and transfusions carried a risk of infection and iron overload. With the advent of genetic engineering, however, scientists were able to create artificial EPO molecules, and administer these to people with renal anemia to replace the missing EPO caused by kidney damage. Commonly, this hormone replacement is given through an intravenous line or by injection. The genetically engineered EPO works in the same way as natural EPO, and promotes production of red blood cells.

Iron supplementation can also be part of an EPO treatment regimen, to ensure the patient has enough iron to make sufficient amounts of hemoglobin. If the patient does not receive enough vitamin B12 or folic acid to replace that lost during dialysis, supplementation with these vitamins may also be necessary. These vitamins may be taken as intravenous injections, injections under the skin, or as tablets.

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