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Renal anemia is a common complication of kidney patients. Especially after renal failure, most patients have renal anemia. Anemia significantly increases the incidence of uremia and all-cause mortality in kidney patients.

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Eight Reasons for Poorly Controlled Renal Anemia

2018-11-21 03:24

Eight Reasons for Poorly Controlled Renal AnemiaRenal anemia is a common complication of kidney patients. Especially after renal failure, most patients have renal anemia. Anemia significantly increases the incidence of uremia and all-cause mortality in kidney patients.

The drugs used to treat renal anemia are mainly erythropoietin, but the effects of the drugs are limited, and many patients are unwilling to cooperate with the treatment, so the effect is usually not satisfied.

Why is the effect of drugs not good? There are several reasons for this:

1. Iron deficiency

It is the most common cause of poor response to treatment with erythropoietin, and the guidelines recommend that iron indicators be monitored once every 3 months during treatment with erythropoietin.

2. Folic acid or vitamin B12 deficiency

Folic acid and vitamin B12 are necessary for the synthesis of hemoglobin. Their deficiency affects the production of red blood cells.

3. Hypothyroidism

The decrease of thyroxine secretion may lead to anemia through such mechanisms as partial effect of iron absorption, reduced metabolic rate of hematopoietic tissue, reduced iron update rate in plasma and red blood cells, and reduction of tissue oxygen consumption. In addition, thyroid hormones directly stimulate the production of blood cells. A small number of patients with hypothyroidism may have antibodies against autoerythrocytes, causing autoimmune hemolytic anemia.

4. Infections/inflammation

Erythropoietin is often poorly treated in patients with infection/inflammation. The infection/inflammation itself can cause normotrophic anemia, which is associated with bone marrow suppression caused by an inflammatory response. Infection/inflammation can affect the absorption, release and distribution of iron by increasing the level of ferritin and activating macrophages. In addition, it may inhibit the production of red blood cells by releasing inflammatory mediators, and it may also block the feedback effect of anemia on the secretion of erythropoietin.

5. Hyperparathyroidism

Hyperparathyroidism may lead to resistance to the erythropoietin, reducing its effectiveness.

6. Chronic blood loss

Chronic blood loss can lead to iron deficiency and reduced response to erythropoietin. It often requires high doses of erythropoietin to maintain a stable hemoglobin level, and patients still have iron deficiency when using intravenous iron agents.

7. Malnutrition

Studies have shown that anaemia in dialysis patients is associated with low serum albumin, so intakes of protein and/or calories may lead to insufficient raw materials for hemoglobin synthesis. Red meat is rich in protein and iron and easy to absorb, making it the best food for improving kidney anemia.

8. Inadequate dialysis

Inadequate dialysis will accumulate excessive toxins, such as guanidine, arginine, and polyamine arginine, which will affect the effect of erythropoietin so as not to improve anemia. Therefore, in clinical work, if the efficacy is not good after the use of erythropoietin, dialysis sufficiency should be evaluated. If dialysis adequacy is not good, high-flux dialysis or hemodialysis filtration can be considered to replace common hemodialysis for better efficacy.

If you have any factors above, you should correct it timely so as to improve anemia.

Hemoglobin levels below 100g/L can cause significant fatigue and other symptoms that can seriously affect quality of life. Patients do not benefit a lot when the drugs are used to elevate the levels to over 115g/L or close to 130g/L. So during the treatment of anemia, patients need to monitor hemoglobin weekly until it rises to between 100 and 115g/L.

Now you have a clear mind of the eight causes of poorly controlled renal anemia. And the material is intended only for purposes. If you have any questions on kidney disease treatment, please consult a physician for specific treatment recommendations.

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