Anemia in Chronic Kidney Disease

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Chronic kidney disease (CKD) affects 37 million people in the United States, and 1 in 7 of them have anemia. In CKD, your kidneys aren't working as well as they should to filter out waste and fluid from the body, and they don't make enough of some important hormones. One common complication of chronic kidney disease is anemia.

This article discusses the symptoms, causes, and treatment of anemia, especially if you have chronic kidney disease.

An imaging technician performing a kidney ultrasound

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What Is Anemia?

Anemia is a blood disorder characterized by a low red blood cell count.

Red blood cells contain a protein called hemoglobin, which is iron-rich and carries oxygen to the rest of your body. Oxygen is the fuel that makes your body function, so if you don't have enough of it reaching your system, you will feel tired and weak.

Severe anemia can lead to a higher risk of heart disease and stroke.

People with chronic kidney disease are prone to anemia because their kidneys don't produce enough of a hormone that stimulates red blood cell production (erythropoietin).


If you have anemia, you may develop a variety of symptoms. Common symptoms of anemia include:

  • Fatigue
  • Feeling cold
  • Shortness of breath
  • Dizziness
  • Weakness or achiness
  • Pale skin
  • Headaches
  • Sleep issues

Causes of Anemia

There are three main factors that can result in anemia: blood loss, underproduction of red blood cells, and destruction of red blood cells.

In chronic kidney disease, there may be more than one reason why you become anemic, including:

  • Your kidneys could be producing less of the hormone erythropoietin that triggers your bone marrow to make red blood cells.
  • Red blood cells live for a shorter time in people with CKD.
  • A lack of nutrients, including iron, folate, and vitamin B12, which are necessary for healthy red blood cell production, are common in people with anemia.

Other causes of anemia related to CKD can include blood loss from dialysis (treatment that uses machines to take over your kidney functions), infection, inflammation, and malnutrition.

Anemia and CKD

Anemia can develop in people with chronic kidney disease because the kidneys are not filtering waste and fluid effectively.

The kidneys produce a hormone, erythropoietin, that tells the body to make red blood cells. If you lack that hormone, your body underproduces red blood cells.

People with early stage chronic kidney disease may not be anemic, but if the disease progresses, it becomes a common complication.

Experts estimate that 1 in 7 people with CKD will develop anemia. If you are over 60 or have diabetes as well as CKD, you are more likely to develop anemia.


If you have chronic kidney disease and have signs or symptoms of anemia, your healthcare provider can do the following to confirm or rule it out. First, they will:

  • Take a medical history, including noting your symptoms, family history of CKD or anemia, and what medications you take
  • Do a physical exam to check your vital signs, including blood pressure and heart rate
  • Look at your skin and check for bruises that may indicate anemia

Blood tests can confirm a diagnosis. The tests can analyze:

  • The number and size of your red blood cells, hemoglobin levels, and the number of developing red blood cells (reticulocytes)
  • The amount of iron in your bloodstream and tissues
  • The amount of ferritin, a protein that stores iron
  • The amount of transferrin, the protein that carries the iron in your blood
  • Folate and vitamin B12 levels, which are important to developing healthy red blood cells

If the tests indicate anemia, there are treatments available to address it.


Treatment for anemia includes treating the underlying condition. If that is addressed, your body can start producing more and healthier red blood cells.

If you have chronic kidney disease, treatments for associated anemia include:

  • Iron, folate, or vitamin B12 supplements: These usually are taken in pill form, though an intravenous (IV) drip of iron into your arm is possible.
  • Erythropoiesis-stimulating agent (ESA) medication: This signals your bone marrow to make more red blood cells. You may be given an IV or it may be delivered in combination with dialysis (a process that filters your blood).
  • Blood transfusions: These are given only in limited circumstances, since they can lower the chance of a person being eligible for a kidney transplant if they have end-stage (severe) chronic kidney disease.

Risks and Complications

Severe anemia with CKD can increase your chance of developing heart problems. This is because the heart is getting less oxygen than it needs, so it has to work harder to pump oxygen-rich red blood cells to your organs and tissues.

People with CKD and anemia may also be at an increased risk for strokes. If you have CKD and are not anemic, your stroke risk is lower.

If you have anemia and CKD, following your healthcare provider's dietary advice is essential. Foods that are high in iron, which could boost red blood cell production, can also be high in nutrients that can be harmful to people with CKD, including protein, sodium, and phosphorus.

Do not change your diet unless doing so under the supervision of a healthcare provider or qualified dietician.


To help prevent anemia with chronic kidney disease, it's important to live a healthy lifestyle that can help address the kidney damage itself.

Diabetes and high blood pressure are the most common causes of CKD. Work with your healthcare provider to get and keep your blood sugar and blood pressure under control.


Anemia is characterized by a low red blood cell count. It is a common complication of chronic kidney disease, because your kidneys are involved in signaling your body to produce red blood cells. If you have anemia with CKD, you may feel tired, weak, cold, and irritable.

If you have chronic kidney disease and develop anemia, treatment is available. Staying as healthy as you can and working with your healthcare provider to reduce the risk of diabetes and high blood pressure will lower your chances of developing complications from chronic kidney disease, including anemia.

A Word From Verywell

If you are living with chronic kidney disease, pay attention to possible signs of anemia, such as feeling tired or chilly, or becoming short of breath on a regular basis. You may have developed anemia as a complication of CKD. Contact your healthcare provider to schedule testing for anemia, which will lead to proper treatment.

Frequently Asked Questions

  • What supplements should you take for anemia?

    If you have chronic kidney disease, do not take supplements for anemia unless advised by your healthcare provider. They can worsen your CKD. Depending on your condition, your provider may recommend iron, vitamin B12, or folate to help your anemia from CKD.

  • Is there a diet for chronic kidney disease?

    A diet for kidney disease involves balance. You want to eat food that gives you the nutrients you need while limiting your intake of substances like potassium, phosphorus, and fluids. You may need to limit the amount of protein as well, and if you have diabetes, your sugar intake. It's important to work with your medical team to develop and follow a recommended diet for kidney disease.

  • Are there foods CKD patients should not eat?

    Depending on the severity of your kidney damage, you may want to avoid foods that are high in potassium, like bananas or avocados. You may also need to limit foods high in phosphorus, like whole grain bread. Talk to your healthcare provider about which foods you should avoid if you have chronic kidney disease.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute of Diabetes and Digestive and Kidney Disease. Anemia in chronic kidney disease.

  2. MedlinePlus. Anemia.

  3. Luthi JC, Flanders WD, Burnier M, Burnand B, McClellan WM. Anemia and chronic kidney disease are associated with poor outcomes in heart failure patientsBMC Nephrol. 2006;7(1):3. doi:10.1186/1471-2369-7-3

  4. Abramson JL, Jurkovitz CT, Vaccarino V, Weintraub WS, McClellan W. Chronic kidney disease, anemia, and incident stroke. Kidney Int. 2003;64(2):610-615. doi:10.1046/j.1523-1755.2003.00109.x

  5. American Kidney Fund. Kidney diet and foods for chronic kidney disease (CKD).

  6. American Kidney Fund. Chronic kidney disease (CKD) symptoms, treatment, causes & prevention.

By Nancy LeBrun
In addition to her extensive health and wellness writing, Nancy has written about many general interest topics for publications as diverse as Newsweek, Teen Vogue,, and Craftsmanship Quarterly. She has authored a book about documentary filmmaking, a screenplay about a lost civil rights hero, and ghostwritten several memoirs.