- Reference Number: HEY792-2024
- Departments: Renal Service
- Last Updated: 1 May 2024
Introduction
This leaflet has been produced to give you general information about your condition. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.
What is renal anaemia?
Renal anaemia (low red blood cell count) is a complication of your kidney disease. Healthy kidneys produce a hormone called Erythropoietin (EPO) to stimulate the production of red blood cells. These red blood cells contain haemoglobin, which is needed to carry the oxygen from your lungs around your body. When your kidneys are not working properly, not enough EPO is produced and your body is unable to make the new red blood cells as needed. Anaemia may or may not cause symptoms, however, common symptoms are listed below:
Symptoms of anaemia may include:
- Pale complexion
- Shortness of breath
- Feeling cold
- Persistent tiredness
- Poor concentration
- Poor appetite
- Low sex drive
- Dizziness
Who do I need iron and/or EPO?
As the anaemia develops over a period of time it is damaging to the heart muscle because it results in the heart having to pump harder and faster to get oxygen around the body. If this goes untreated for a long period of time this can result in the heart muscle becoming thick and stiff and unable to pump effectively. Treatment for your anaemia is an important part of your overall treatment plan and may improve your symptoms and make you feel better.
What are your options?
The body requires adequate stores of vitamins, folic acid and B12 which are necessary to help make the red blood cells. As part of your assessment we will measure these levels and you may need to take supplements. If this applies to you we will inform you of the treatment required.
Treatments can include:
Replacing iron:
- Iron Tablet
- Iron drip (infusion)
Replacing folate:
- Folic acid tablet/ Renavit
Replacing B12
- B12 injection
- B12 tablet
Increasing the production of red blood cells
- Manufactured EPO (injection)
- HIF-inhibitor Therapy (HIF-IT) – (tablet)
Why might you need iron drip instead of tablet?
Sometimes iron can be poorly absorbed or causes stomach upset. In this case we will advise switching to iron drip (infusion). If you are taking oral iron, we need you to stop taking, before you come in for iron treatment through a drip.
What is the difference between EPO and HIF-IT?
Manufactured EPO and HIF-IT both work to increase red blood cell production. Manufactured EPO replaces the EPO your kidneys cannot produce whilst HIF-IT helps your kidneys make EPO. HIF-IT can also reduce the need for iron and blood transfusions).They are both equally effective and your doctor will discuss treatment options with you.
What will happen?
Iron therapy
We will try to provide your infusion of iron as near to your home as possible at your local hospital but it may require a visit to the Hull University Teaching Hospital NHS Trust Medical Day Unit. It is important that you tell us if you have any allergies or if you are asthmatic before we give you any intravenous iron therapy.
Possible side effects of iron:
- Nausea
- Dizziness
- Headache
- Rash
- Metallic taste
Serious reactions requiring medical attention are very rare. A rare complication of iron infusion is a brown stain to the skin. An iron infusion is given in the veins, via a cannula. If iron leaks out of the cannula into the skin, it can leave a brown stain. It is uncertain if and how long this will take to resolve. This can usually be prevented by ensuring the cannula is well secured.
EPO therapy
EPO injection is usually given monthly, until your anaemia has been corrected, but occasionally the dose or frequency may change depending on your blood results.
You will be encouraged to learn to administer it yourself, or we may be able to show someone nominated by yourself, to give you the injection. In some instances the nurse at your doctor’s surgery or the district nurse may give the injection for you. If you start haemodialysis (HD) or peritoneal dialysis (PD) this treatment can continue if required.
It is important that your blood pressure is monitored closely because, as the EPO works and your haemoglobin rises, so can your blood pressure. Again this can be monitored by you, your practice nurse, district nurse or dialysis nurse.
For EPO to work effectively your body needs adequate iron stores and you may from be asked to attend the hospital for an iron infusion, which is given via a drip, to ensure you have enough iron to support the formation of good quality red blood cells. Not all patients need to have EPO and sometimes giving iron is enough to correct your anaemia. You will be told if this applies to you.
HIF-inhibitor Therapy (HIF-IT)
HIF-IT is a tablet used to treat anaemia due to chronic kidney disease (CKD) and can continue after a patient starts dialysis if required. You will need to take the tablet three times a week, usually on a Monday, Wednesday and Friday, and take on the same days each week.
It can cause loose stools and swelling of the feet. It is important that your blood pressure is monitored closely because, as the medication works and your haemoglobin rises, so can your blood pressure.
What happens afterwards?
A nurse practitioner who specialises in anaemia management will coordinate your care. The nurse will be available for support and queries for patients, carers, health professionals and hospital staff on all aspects of your anaemia management.
The nurse will provide you with the information required to ensure safe and efficient treatment for your anaemia and arrange the supply of EPO or HIF-IT from our Home Delivery Service.
You may be asked to ring regularly with blood pressure readings that your doctor has taken and to inform us that you have had your blood tests done.
Should you require further advice please contact the renal nurse specialist on tel: 01482 608754 – Monday to Friday from 7:00 am to 3:00 pm. At weekends, messages can be left on the answerphone and will be checked on the next working day.
