patients with sickle cell disease. AJR Am J Roentgenol. 2012;198(5):1167-1174. 17. Feliu MH, Crawford RD, Edwards L, et al. Neurocognitive testing and functioning in adults sickle cell disease. Hemoglobin. 2011;35(5-6): 476-484. 18. Jorgensen DR, Rosano C, Novelli EM. Can neuroimaging markers of vascular pathology explain cognitive performance in adults with sickle cell anemia? A review of the literature. Hemoglobin. 2016;40(6):381-387. 19. Sanger M, Jordan L, Pruthi S, et al. Cognitive deficits are associated with unemployment in adults with sickle cell anemia. J Clin Exp Neuropsychol. 2016;38(6):661-671. 20. Jordan LC, DeBaun MR. Cerebral hemodynamic assessment and neuroimaging across the lifespan in sickle cell disease [published online ahead of print]. J Cereb B National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative Did you know that the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (NKFKDOQI™) develops guidelines that help your doctor and healthcare team make important decisions about your medical treatment? The information in this booklet is based on the NKF-KDOQI recommended guidelines. Stages of Chronic Kidney Disease There are five stages of chronic kidney disease. They are shown in the table below. Your doctor determines your stage of kidney disease based on the presence of kidney damage and your glomerular filtration rate (GFR), which is a measure of your level of kidney function. Your treatment is based on your stage of kidney disease. Speak to your doctor if you have any questions about your stage of kidney disease or your treatment. Stages of Kidney Disease Stage Description Glomerular Filtration Rate (GFR)* 1 Kidney damage (e.g., protein in the urine) with normal GFR 90 or above 2 Kidney damage with mild decrease in GFR 60 to 89 3 Moderate decrease in GFR 30 to 59 4 Severe reduction in GFR 15 to 29 5 Kidney failure Less than 15 www.kidney.org 3 What is anemia? Anemia happens when your red blood cells are in short supply. Red blood cells carry oxygen from your lungs to all parts of your body, giving you the energy you need for your daily activities. Anemia can cause you to: n Look pale n Feel tired n Have little energy for your daily activities n Have a poor appetite n Have trouble sleeping n Have trouble thinking clearly n Feel dizzy or have headaches n Have a rapid heartbeat n Feel short of breath n Feel depressed or “down in the dumps” 4 National Kidney Foundation What are some causes of anemia? Anemia can be caused by: n Diseases like kidney disease, liver disease, HIV/AIDS, systemic lupus erythematosus or cancer n Diseases that harm or destroy your blood cells, such as sickle cell disease n Blood loss from accidents, surgery, stomach ulcers, kidney or bladder tumors, cancer or polyps in the intestines or other causes n An infection or inflammation in your body n Too little iron, vitamin B12 or folic acid in your body Iron is a mineral that you get from eating foods like liver and leafy, green vegetables. Both vitamin B12 and folic acid are important vitamins that you get from eating foods www.kidney.org 5 like eggs, fish and liver. Your body needs these important minerals and vitamins to help make red blood cells. n A poor diet You can become anemic if you do not eat healthy foods with enough vitamin B12, folic acid and iron. Your body needs these important vitamins and minerals to help make red blood cells. Before starting anemia treatment, your doctor will order tests to find the exact cause of your anemia. Why do people with kidney disease get anemia? Your kidneys make an important hormone called erythropoietin (EPO). Hormones are secretions that your body makes to help your body work and keep you healthy. EPO tells your body to make red blood cells. When you have kidney disease, your kidneys cannot make enough EPO. This causes your red blood cell count to drop and anemia to develop. 6 National Kidney Foundation Are all people with kidney disease at risk for anemia? Most people with kidney disease will develop anemia. Anemia can happen early in the course of kidney disease and grow worse as kidneys lose their ability to work well and make EPO. Anemia is especially common if you: n Have diabetes n Are African American n Have moderate or severe loss of kidney function (stage 3 or 4) n Have kidney failure (stage 5) n Are female FACT If you are African American or have diabetes and chronic kidney disease, you are more likely to get anemia and at an earlier stage of kidney disease. www.kidney.org 7 How do I know if I have anemia? Not everyone with anemia has symptoms. If you have kidney disease, you should have a blood test to measure your hemoglobin level at least once per year to check for anemia. Hemoglobin is the part of red blood cells that carries oxygen throughout your body. Your doctor can tell if you have anemia by measuring your hemoglobin. If your hemoglobin level is lower than the normal range (which is 12.0 for women and 13.5 for men), it is likely you have anemia. In that case, your doctor will check to find the exact cause of your anemia and develop a treatment plan that is right for you. TIP Speak to your doctor if you think you have anemia. Make a list of questions. Write down your symptoms, allergies, medications, previous medical and other health problems. Show the list of symptoms to your