Explain anemia and why dialysis patients have it. Youhaveanemiawhentherearenotenoughredbloodcellsinyourblood.

Redbloodcellshavehemoglobin,whichcarriesoxygenthroughoutyourbody.Withoutenoughhemoglobinandoxygen,youdonotfeelwell.

Peoplewithanemiahavealowhemoglobinlevel.

Mostpeopleondialysishaveanemiabecause:

Yourkidneysarenotmakingenoughofahormonecallederythropoietintohelpyourbodymakeredbloodcells.

Youoftenlosesomebloodduringhemodialysistreatmentsandbloodtesting.

Youmayhavelowlevelsofiron.Ironisneededtomakehemoglobin.Peopleondialysisdontusuallygetenough ironintheirdiet.

YoumayhavelowlevelsofvitaminB12orfolate.Thesevitaminsarealsoneededtomakeredbloodcells.

Treatmentisavailable.

EDUCATE YOUR DIALYSIS PATIENTS ABOUT ANEMIA

1

Explain signs and symptoms of anemia. Whenyouhaveanemia,youmay:

Feeltired Feeldizzyorhaveheadaches

Havearapidheartbeat Havelittleenergyforyourdailyactivities

Haveapoorappetite Feelshortofbreath

Feeldepressedordowninthedumps Havetroublesleeping

Havetroublethinkingclearly Lookpale

2

Explain anemia therapy. Themaingoalsfortreatinganemiaareto:

Preventserioushealthproblems(havinganemiaforalongtimecanleadtoheartdiseaseandan increasedriskofdeath)

Helpyoufeelbetterandimproveyourqualityoflife

Lessentheneedforbloodtransfusions

Erythropoiesis-stimulatingagents(ESAs)actlikethehormoneerythropoietinfromhealthykidneysandhelpyourbodymakeredbloodcells.

TheamountofESAyougetdependsonyouroverallhealthandmedicalhistory,bodyweight,hemoglobinlevel,andhowyoufeel.YourdoctormaylowerorstopyourESAdosageifyourbloodpressureisincreasing.YoumaynotgetanESAifyouareathighriskforstrokeorhaveahistoryofcancer.ESAscanbegivenasashotundertheskinorthroughthehemodialysisaccess.

Youneedtohaveenoughirontomakeredbloodcells.Infact,onceyoustartgettingESAs,youwillmakemoreredbloodcellsandyourironsupplywillbeusedupfaster.TakingextraironmayhelpsolvethisproblemandmakeyourESAtreatmentmoreeffective.Ifyouareonperitonealdialysis,youcangetironasapillorasaninjectionthroughavein.Ifyouareonhemodialysis,itcanbegiventhroughthehemodialysisaccess.

AfteryoubeginESAandirontreatment,youshouldbegintofeelbetterandhaveenergytodomorethings.Thetimeittakestofeelbetterisdifferentforeveryone.

3

Explain how patients are checked for anemia. Yourdialysisteamwillorderthesebloodteststoseehowwellyouranemiatreatmentisworking:

Hb(hemoglobin):showsifyourredbloodcellscancarryenoughoxygenthroughyourbody

TSAT(transferrinsaturation):measurestheamountofironinyourblood

Ferritin:measurestheamountofironstoredinyourbody

Thebestresultsofthesetestsaredifferentforeachperson,soyouranemiatreatmentwillbemadejustforyou.

Yourdoctorandnurseswillcheckyourbodyforsignsofanemiaandaskyouhowyouarefeeling.

4

Explain potential risks and benefits of blood transfusions. Transfusionsarelife-saving.Theymaybeusedinurgentsituationssuchasheavybleeding,emergencysurgery,or

treatingheartdiseasemadeworsebyanemia.

Yourdoctormayalsofeelthatyouneedatransfusionbecauseyouranemiatreatmentsarenotworkingandyouhaveseveresignsofanemia.

Ifyoudoneedatransfusion,askforleukopoorandirradiatedbloodbecausethistreatmentcanreducesomeoftheriskslistedbelow.

Possiblerisksfrombloodtransfusionsinclude:

Allergicreactions

Reactionsthatcausefever

Lunginjury(uncommon)

Reactionsthatcauseredbloodcellstobreakopen(uncommon)

Infections(rare)

Increasingthetimeyouwaitforatransplant

5

Explain actions that patients can take to improve outcomes and avoid the need for transfusions. Donotmiss: Scheduledhemodialysistreatments

Scheduledperitonealexchanges

PrescribeddosesofyourESAandiron

Takeallmedicationsandsupplementsasprescribed.

FollowyourdoctorsorderstoeitherlowerthedoseorstoptheuseofbloodpressurepillscalledACEinhibitorsandARBs.Thesedrugscanmakeitharderforyoutomakeredbloodcells.

Makesureyouunderstandtherisksandbenefitsofatransfusionandwhattowatchoutforifyourdoctorrecommendsoneforyou.

Getabloodpressuremonitorandtakeyourpressureeverymorningandnight.Tellyourdoctoraboutthebloodpressureresults.Thetargetbloodpressurebeforedialysisis140/90and,afterdialysis,130/80,butyourdoctormayhavedifferenttargetsforyou.

Donotsmoke.Stayclearofsecond-handsmoke.

Ifyouhavetroublesleepingorwakeupbecauseitishardtobreathe,letyourdoctorknow.Ifyouhavesleepapnea,alwaysusethedeviceprescribedbyyourdoctor.

Talkwiththedietitianandfollowadialysis-friendlydiet.

Talktoyourdoctoraboutexercisingwhileondialysisorbetweentreatments.Itmayhelp.

6

2012 National Kidney Foundation, Inc. All rights reserved. 12-10-4750_DBC Made Possible with an Educational Grant from