Kidney Diet Tips

Anemia and Chronic Kidney Disease

People with chronic kidney disease (CKD) and those on dialysis are at risk for anemia. Chronic anemia reduces overall quality of life. It also increases risk of hospitalization and death.

Symptoms of Anemia

Some of the symptoms of anemia that a person may experience include:

  • Pale skin
  • Inability to concentrate
  • Chronic fatigue and/or trouble sleeping
  • Dizziness
  • Headaches
  • Decreased oxygen delivery to the body
  • Trouble breathing
  • Depression
  • Decreased sexual function
  • Changes in the menstrual cycle
  • Enlarged heart (cardiomegaly), congestive heart failure, and/or chest pain (angina)
  • Malnutrition

Anemia Development

The kidneys produce about 90% of all erythropoietin (EPO) in the body. This is the hormone responsible for producing new red blood cells. Therefore, a decline in kidney function reduces the kidneys ability to produce this hormone. This can lead to low red blood cell counts known as anemia.

Anemia Management

Thankfully, scientists were able to create erythropoiesis-stimulating agents (ESA’s) through genetic engineering. ESA’s are man-made versions of EPO. Normally these drugs are very effective at treating anemia. However, iron deficiency can cause resistance to these treatments. Iron deficiency can be treated with iron supplements taken by mouth or with intravenous (IV) iron. Oral iron supplements are often prescribed as 200 mg of elemental iron two to three times daily, but needs vary person to person. It is important to check with a doctor before starting an oral iron regimen.

Increasing dietary iron is also helpful. Some good sources or iron include lean meats, poultry and seafood, and iron fortified and enriched cereals and rice. Including a source of vitamin C, like strawberries, with iron-rich foods helps with absorption.

Anemia can also be caused by other dietary factors such as lack of folic acid (vitamin B9) and/or methylcobalamin (vitamin B12). People on dialysis are recommended to consume 1 mg of folic acid daily and 2.4 mcg of vitamin B12 daily. Needs may be higher when a person is anemic due to deficiencies of these vitamins. Talk with a doctor or registered dietitian (RD) about kidney friendly vitamins that may be prescribed to prevent or treat anemia.

Anemia Monitoring

Anemia is monitored using routine blood testing for hemoglobin (Hgb) and hematocrit (Hct). The normal laboratory reference range is provided on the lab report. However the goal for people with kidney disease may be different. The Kidney Disease Improving Global Outcomes (KDIGO) Guideline for Anemia in Chronic Kidney Disease recommends that anemia treatment be individualized for each patient. Ask your doctor about your goals for hemoglobin and hematocrit.

Additional Reasons for Anemia

In addition to the above reasons, there are more things to consider when a person has anemia. Additional reasons include:

  • excessive blood work/laboratory testing
  • blood residue left in dialyzers or blood lines
  • blood lost in the stool due to gastrointestinal injury
  • heavy menstrual cycle bleeding
  • excessive bleeding from a fistula or graft

Ask your doctor and dietitian for information about your personal status and treatments you may be getting for anemia or anemia prevention.


  1. National Kidney Foundation. Updated August 3rd, 2016.
  2. A Clinical Guide to Nutrition Care in Kidney Disease, 2nd edition by Laura Byham-Gray, Jean Stover, and Karen Wiesen.
  3. Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney inter., Suppl. 2012; 2: 279–335.

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

Erika Stahl, RD, CSR, CNSC

Erika Stahl, RD, CSR, CNSC

Erika Stahl is a Registered Dietitian (RD) and Board Certified Specialist in Renal Nutrition (CSR). Erika has been working as a dietitian for 4 years and prior to becoming a dietitian, worked as a dietetic technician registered. Erika works full time as a dialysis dietitian but also privately counsels clients with Celiac Disease on how to follow a gluten-free diet.