WHAT YOU NEED TO KNOW ABOUT ANEMIA AND DIALYSIS

What is anemia and why do people on dialysis have it?• Youhaveanemiawhentherearenotenoughredbloodcellsinyourblood.

• Redbloodcellshavehemoglobin,whichcarriesoxygenthroughoutyourbody.Withoutenoughhemoglobinandoxygen,youdonotfeelwell.

• Peoplewithanemiahavealowhemoglobinlevel.

• Mosteveryoneondialysishasanemiabecause:

❑ Yourkidneysarenotmakingenoughofahormonecallederythropoietintohelpyourbodymakeredbloodcells

❑ Youoftenlosesomebloodduringhemodialysistreatmentsandbloodtesting

❑ Youmayhavelowlevelsofiron.Ironisneededtomakehemoglobin.Peopleondialysisdon’tusuallygetenoughironintheirdiet.

❑ YoumayhavelowlevelsofvitaminB12orfolate.Thesevitaminsareneededtomakeredbloodcells.

• Treatmentisavailable.

What are signs and symptoms of anemia?• Whenyouhaveanemia,youmay:

❑ Feeltired ❑ Feeldizzyorhaveheadaches

❑ Havearapidheartbeat ❑ Havelittleenergyforyourdailyactivities

❑ Haveapoorappetite ❑ Feelshortofbreath

❑ Feeldepressedor“downinthedumps” ❑ Havetroublesleeping

❑ Havetroublethinkingclearly ❑ Lookpale

How is anemia treated?• Themaingoalsfortreatinganemiaareto:

❑ Preventserioushealthproblems(havinganemiaforalongtimecanleadtoheartdisease)

❑ Helpyoufeelbetterandimproveyourqualityoflife

❑ Lessentheneedforbloodtransfusions

• Erythropoiesis-stimulatingagents(ESAs)actlikethehormoneerythropoietinfromhealthykidneysandhelpyourbodymakeredbloodcells.TheamountofESAyougetdependsonyourmedicalhistory,bodyweight,yourhemoglobinlevel,andhowyoufeel.YourdoctormaylowerorstopyourESAdosageifyourbloodpressureisincreasing.YoumaynotgetanESAifyouareathighriskforstrokeorhaveahistoryofcancer.ESAscanbegivenasashotundertheskinorthroughthehemodialysisaccess.

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

How does my doctor check me for anemia?• Yourdialysisteamwillorderthesebloodteststoseehowwellyouranemiatreatmentisworking:

❑ Hb(hemoglobin):showsifyourredbloodcellscancarryenoughoxygenthroughyourbody

❑ TSAT(transferrinsaturation):measurestheamountofironinyourblood

❑ Ferritin:measurestheamountofironstoredinyourbody

• The“best”resultsofthesetestsaredifferentforeachperson,soyouranemiatreatmentwillbemadejustforyou.

• Yourdoctorandnurseswillcheckyourbodyforsignsofanemiaandaskyouhowyouarefeeling.

What are the risks and benefits of blood transfusions?• Transfusionsarelife-saving.Theymaybeusedinurgentsituationssuchasheavybleeding,emergency

surgery,andtreatingheartattacksmadeworsebyanemia.Yourdoctormayalsofeelthatyouneedatransfusionbecauseyouranemiatreatmentsarenotworkingandyouhaveseveresignsofanemia.

• Ifyoudoneedatransfusion,askfor“leukopoorandirradiated”bloodbecausethistreatmentcanreducesomeoftheriskslistedbelow.Possiblerisksfrombloodtransfusionsare:

❑Allergicreactions

❑Reactionsthatcausefever

❑Lunginjury(uncommon)

What can I do to help my anemia and to avoid blood transfusions?• Donotmiss:

❑Scheduledhemodialysistreatments

❑Scheduledperitonealexchanges

❑PrescribeddosesofyourESAandiron

• Takeallmedicationsandsupplementsasprescribed.

• Followyourdoctor’sorderstoeitherlowerthedoseorstoptheuseofbloodpressurepillscalledACEinhibitorsandARBs.Thesedrugscanmakeitharderforyoutomakeredbloodcells.

• Understandtherisksandbenefitsofatransfusionandknowwhattowatchoutforifyourdoctorrecommendsoneforyou.

• Getabloodpressuremonitorandtakeyourpressureeverymorningandnight.Tellyourdoctorabouttheresults.Thetargetbloodpressurebeforedialysisis140/90and,afterdialysis,130/80,butyourdoctormayhavedifferenttargetsforyou.

• Donotsmoke.Stayclearofsecond-handsmoke.

• Ifyouhaveanytroublesleepingorwakeupbecauseitishardtobreathe,letyourdoctorknow.Ifyouhavesleepapnea,alwaysusethedeviceprescribedbyyourdoctor.

• Talkwiththedietitianandfollowadialysis-friendlydiet.

• Talktoyourdoctoraboutexercisingwhileondialysisorbetweentreatments.Itmayhelp.

© 2012 National Kidney Foundation, Inc. All rights reserved. 11-10-4751_DBC Made Possible with an Educational Grant from

❑Reactionsthatcauseredbloodcellstobreakopen(uncommon)

❑Infections(rare)

❑Increasingthetimeyouwaitforatransplant