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Ovid: Oxford Handbook of Dialysis

Editors: Levy, Jeremy; Morgan, Julie; Brown, Edwina Title: Oxford Handbook of Dialysis, 2nd Edition Copyright ©2004 Oxford University Press > Table of Contents > Part 8 – Complications of ESRD: anaemia > Causes of anaemia Causes of anaemia Anaemia is universal in ESRD, primarily due to a relative lack of EPO. Plasma EPO levels are within the ‘normal’ range (6–30 mU/ml), but not increased to the levels seen in other severe anaemias (>100 mU/ml), due to the failure of diseased renal tissue to respond to the anaemic hypoxic stimulus. Anaemia usually develops as the GFR falls below 35 ml/min, and worsens with declining GFR. Other causes of anaemia in renal failure include:

  • shortened red blood cell survival;
  • uraemic and cytokine inhibition of erythropoiesis (especially infections and inflammatory conditions);
  • iron deficiency;
  • hypothyroidism;
  • active blood loss (including HD circuits, GI bleeding);
  • haemolysis;
  • haemoglobinopathies;
  • aluminium overload;
  • hyperparathyroid osteitis fibrosa;
  • folic acid or vitamin B12 deficiency.

Anaemia in ESRD is not a trivial problem. There is a strong association between Hb and risk of death in ESRD. Increasing Hb causes major improvements in quality of life, exercise capacity, cognitive function, sexual function, immune responsiveness, nutrition, sleep patterns, and improved cardiac status (reduced LVH and dilatation, reduced cardiac output, reduced angina).

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