Saturday, February 20, 2021

From the patient's perspective: What to do about Anemia on Dialysis?


Anemia is one of the most common problems faced by dialysis patients. The Mayo Clinic website describes it below:

"Anemia is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues. Having anemia can make you feel tired and weak."

Dialysis patients have poorly functioning kidneys. Apart from the cleaning of toxins and fluid, kidneys do several other very important things. One of these is to produce a hormone called Erythropoietin. This hormone, Erythropoietin stimulates Red Blood Cell (RBC) production in the bone marrow. So when the kidneys don't function optimally, the production of RBCs falls. This manifests as a low Hemoglobin, which is a protein that carries oxygen from the lungs to the tissues in the body.

Patients with low Hemoglobin have weakness, tiredness, shortness of breath and an increased risk of infection.

That is why, when a dialysis patient has a low Hemoglobin value, their nephrologist prescribes injections of this hormone Erythropoietin or an equivalent drug. By injecting this drug, the stimulation of RBCs in the bone marrow improves and symptoms associated with anemia abate.

Some people have a misconception that eating food rich in iron like Spinach and Dry Grapes etc. will help correct this anemia. This is not correct. The reason for the anemia is the lack of the hormone, Erythropoietin. So eating any amount of Spinach will not correct that.

Sometimes, the body does not have enough iron. Here, Erythropoietin may not work. Nephrologists prescribe Intravenous injections of Iron to correct this condition. Spinach and Dry Grapes work too slowly and too minutely to correct this problem. They also have high Potassium, which may be a problem with patients who have a high Serum Potassium. The Serum Iron and Transferrin Saturation blood tests will tell you the status of the Iron Stores.

One thing to remember with Anemia in Dialysis patients is that Hemoglobin value we must target differs from that in people with healthy kidneys. While healthy males target 13.5 to 17.5 g/dL and females target 12 to 15.5 g/dL, the target for dialysis patients currently is 9 to 11.5 g/dL. Again, this may vary depending on your nephrologist's overall evaluation of your health. Some nephrologists take target 10 to 11.5 g/dL.

Why should hemodialysis patients have a lower target than the healthy population? Higher hemoglobin values have shown to pose a risk to AV Fistulas and also affect the heart.

It is important to correct anemia for dialysis patients. Please test for hemoglobin regularly. Also, make sure you discuss with your nephrologist if your hemoglobin is below 9 g/dL or is above 11.5 g/dL. Also test your Serum Iron and Transferrin Saturation periodically, especially if you've been taking Erythropoietin regularly and your Hemoglobin is not going up.

Correcting anemia is one of the most important things you can do to remain healthy while on dialysis. By doing this in a timely manner, you will also avoid blood transfusions, which may be needed in an emergency if your blood counts go too low. This increases your risk of contracting blood-borne infections like Hepatitis C, Hepatitis B and HIV. So, take this seriously and follow your doctor's prescription.

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