Anemia means a low number of red blood cells.  Red blood cells carry oxygen to all parts of your body.  When you have a low number of red blood cells, you may feel weak or sleepy and you may not have enough energy to work, exercise or simply visit with your family or friends.

What does this have to do with kidney disease?

Kidneys, in addition to being a filter, also make a hormone (special messenger) called erythropoietin, or, EPO for short.  EPO tells the body to make more red blood cells when the count is low.  However, when kidneys get sick and weakened, the kidney cannot make enough EPO to tell the body to make more red blood cells. 

How is anemia diagnosed?

Your doctor will check a hemoglobin.  This test tells us about how many red blood cells are in your blood.  When you have a hemoglobin of <10, your doctor may talk to you about receiving a medication called epo.

Your doctor will also check the iron level of your blood.  Iron is needed for your body to make blood.  It is important that you have enough iron in your body in order for the epo to work.

Why do I need to receive epo?

In addition to the above, you may feel weak and tired.  You may have less energy to do your normal activities.  Epo can make you feel better.  It may give your energy level a boost. 

How do I receive epo?

Epo is manmade to be exactly the same hormone your kidneys used to make.  The only way to receive epo is to receive an injection under the skin of your upper arm.  Your doctor and anemia care team determine how much and how often you need to get this shot.

Most patients who receive epo at our clinic come once a month.  We do have some patients who come once a week, every other week, or, even every six weeks.  There is no rhyme or reason as to how frequent you need to come.  Every patient is different.

We have 2 different types of epo to give you at our office:

Aranesp (darbepoeitin)

Procrit (erythropoeitin)

We mainly use Aranesp because it can be last longer in your body than Procrit.  Some insurance companies require us to use Procrit instead of Aranesp.  We can determine the type you receive by verifying the medication with your insurance carrier.  You do not need to do anything!

Is Procrit better than Aranesp?

Neither type of epo is better than the other. However, there are side effects associated with the use of either form of epo.  The side effects are the same.  Your doctor will discuss the side effects with you prior to you receiving any epo.  You can read about the side effects.  Procrit    Aranesp

What are the steps we take to minimize side effects and monitor your progress?

You will get a hemoglobin once a month.  Our goal is to keep your level between 10.5 and 12.  The risk of the side effects increases if your hemoglobin is above 13.  FOr this reason, we are very particular about watching your progress on epo.  You will only get a shot if you have a monthly test and if you are not above 12.5.

Some patients may have a hemoglobin >13 after an epo shot.  When this happens we simply stop giving you the epo until your hemoglobin is <12.  Then, we decrease your dose. 

What won’t epo do?

Epo will not make your kidney function better.  The goal of epo therapy is to make you feel better so you have more energy to carry out your normal daily activities.

What about iron?

Iron is a necessary building block to make more blood.  If your iron levels are low, your care team may prescribe iron pills to take once or twice a day.  For some people, it is very hard to tolerate iron pills.  And, for some others, it is hard for their bodies to absorb the iron from a pill taken by mouth.

Fortunately, we have iron that can be safely given as an infusion.  This type of iton is called Fereheme.  It is given as a constant infusion over just a few minutes.  Your care team can make arrangements for you if your doctor feels this is necessary.

****************************************************************************

If you want more information on anemia, please ask your care team!

More information can also be found at these sites:

American Association of Kidney Patients: Anemia

National Kidney Foundation: Anemia