doctor. Discuss how you are feeling and ask questions. 8 National Kidney Foundation How is anemia treated? Your treatment will depend on the exact cause of your anemia. If your anemia is due to kidney disease, you will be treated with: n Drugs called erythropoiesisstimulating agents (ESAs) ESAs help your body make red blood cells. ESAs will usually be given to you as an injection under the skin (called a subcutaneous injection) in your doctor’s office. n Extra iron Your body also needs iron to make red blood cells— especially when you are receiving ESAs. Without enough iron, your ESA treatment will not work as well. Iron can be given to you as a pill, or administered directly into a vein in your doctor’s office or clinic. TIP Not having enough EPO (a hormone made by your kidneys) is the most common cause of anemia in patients with kidney disease. EPO tells your body to make red blood cells. When your kidneys no longer make enough EPO, treatment with an ESA can help. www.kidney.org 9 What is the goal of anemia treatment? The goal of anemia treatment in most cases is to increase your hemoglobin level to be between 11 and 12. As you get closer to this range, you should notice that you have more energy and feel less tired. How much ESA will I need? Your doctor will prescribe enough ESA to increase your hemoglobin gradually to the recommended level. How much ESA you need and how often you receive it depends on: n Your current hemoglobin level n How well you respond to treatment with ESA n The type of ESA you receive There are different types of ESAs available—short-acting ESAs or long-lasting ESAs. You and your doctor will decide which type is best for you. Speak to your doctor if you are ever discharged from a hospital. Your doctor may want to modify your anemia treatment plan to maintain your target hemoglobin. TIP 10 National Kidney Foundation How will my doctor know if I am responding to ESA? Your doctor will check your hemoglobin level at least monthly. This tells your doctor how well you are doing. Your dose of ESA may need to be changed, depending on how well you respond to your treatment. Will I need extra iron? Your body needs iron to make red blood cells. Once you start taking an ESA your body will make more red blood cells, and your body’s iron supply will be used up faster. Without extra iron, your ESA treatment will not be effective. www.kidney.org 11 How much iron will I need? Your doctor will decide how much iron you need and how often you get it based on your hemoglobin level, ESA dose and the results of your iron tests. The goal of taking extra iron is to make sure you have enough iron to reach a hemoglobin between 11 and 12. How is my iron level tested? Two important tests can tell if you have enough iron. They are called transferrin saturation (TSAT) and ferritin. To make sure you have enough iron to reach the desired hemoglobin: n Your TSAT should be at least 20 percent. n Your ferritin should be at least 100 ng/mL. How often will my iron level be tested? If you are being treated for anemia with an ESA, your iron should be tested every month until your anemia is under control. If you do not have anemia or if your anemia is under control, your iron level should be checked every three months. 12 National Kidney Foundation Can diet help my anemia? Eating foods that are high in iron, vitamin B12 and folic acid may be helpful for some patients with anemia. Your dietitian can help you plan meals to include foods that are good sources of these vitamins and minerals. Check with your doctor before making any changes in your diet. What if my anemia isn’t treated? If untreated, anemia can cause serious problems. Anemia can make your other health problems worse. A low supply of red blood cells in your body (anemia) can make your heart work harder. This can lead to a type of heart disease called left ventricular hypertrophy (LVH). Unfortunately, many people with kidney disease develop LVH long before they FACT Iron is important in treating anemia. Without enough iron, ESA is wasted and you will not reach your target hemoglobin. www.kidney.org 13 reach kidney failure, and some will even die from it. Early treatment of anemia may help prevent this problem and other serious complications from happening. What if I have a kidney transplant? Unfortunately, even a new kidney may not be able to make all the EPO you need to make enough red blood cells. One reason this happens is because the immunosuppressive drugs needed after getting a new kidney can affect EPO production. So, treatment for anemia is often necessary even after a successful transplant. FACT Treating your anemia is important because: n Your chance of having serious, lifethreatening heart problems is lower. n You will have more energy to do your daily tasks. n Your quality of life gets better. n Your ability to exercise improves. 14 National Kidney Foundation If you have questions, speak with your healthcare team. They know you and can answer questions about you. If you want to read more about kidney disease, the National Kidney Foundation has more than 50 other publications that cover many subjects, such as: n CKD risk factors like hypertension and diabetes n Complications of chronic kidney disease, such as cardiovascular disease, anemia or bone problems n Nutrition for CKD patients, with information about carbohydrates, protein, sodium,