Iron, Anemia, and Dialysis
Iron makes red blood cells, which carry oxygen throughout the body. This oxygen is
necessary for energy. The kidneys signal the body to make red blood cells, but when you
have chronic kidney disease, the kidneys may not secrete enough erythropoietin to send
this signal.
If enough red blood cells are not made, a person develops anemia. Iron is important for
the health of red blood cells. Your doctor may prescribe an erythropoietin-stimulating
agent, and you will need extra iron to increase the medication’s effectiveness. This is
because your iron will become depleted as it is used in new hemoglobin molecules
created after administration of the erythropoietin. Iron and oxygen make hemoglobin,
which is the part of the red blood cell that carries oxygen.
Testing
You will receive iron testing each month until your hemoglobin reaches normal levels,
after which you will have testing every 3 months. If you have kidney disease, you should
have your hemoglobin measured at least annually.
Cardiac problems
Anemia is even more likely to occur in people who have diabetes, are African American,
or are female. Anemia can cause serious, life-threatening cardiac problems. When a
person is anemic, the heart has to work harder to pump blood throughout the body in
order to meet oxygen demands. This leads to thickened muscle on the left side of the
heart, which results in a condition called left ventricular hypertrophy. It is estimated that
80% of patients have left ventricular hypertrophy when they start dialysis. Having high
blood pressure also increases the risk for developing left ventricular hypertrophy.
Iron-deficiency anemia
People on dialysis are at an even greater risk for developing iron-deficiency anemia,
because their diet is more limited and blood is lost during dialysis.
Symptoms of iron-deficiency anemia include:
 Lethargy
 Weakness
 Pallor
 Depression
 Irritability
 Poor appetite
 Trouble breathing
 Chest pain
 Dizziness or light-headedness
 Headaches
 Confusion
 Insomnia
 Cravings for strange things, such as dirt or ice
 Numbness or coldness of the extremities
 Tachycardia
 Brittle fingernails
 Restless legs syndrome
Tips to help you feel better
These suggestions might help you feel better:
 See a dietitian, who can help you work iron-rich foods, such as the following, into your
diet:
– Beef liver
– Beef, pork, venison, and lamb
– Cream of Wheat®
– Dried fruits (raisins, dates, prunes, and apricots)
– Fish and shellfish
– Greens (spinach, kale, mustard greens, collard greens, and turnip greens)
– Iron-fortified whole grains
– Legumes and beans
– Poultry (turkey, chicken, etc)
– Raisin bran
– Some vegetables (broccoli, asparagus, Brussels sprouts, potatoes, and peas)
– Tofu and soy-based meat alternatives (veggie burgers)
 Take an iron supplement as prescribed by your physician
 Follow your doctor’s advice about taking a multivitamin and mineral supplement that
contains iron, vitamin B12, and folic acid
 Receive intravenous iron at your doctor’s office, if suggested
References and recommended readings
American Association of Kidney Patients. Anemia and kidney disease: what you should
know. Available at: http://www.aakp.org/aakp-library/anemia-kidney-disease/. Accessed
September 4, 2012.
National Kidney Foundation™. Anemia and Chronic Kidney Disease: Stages 1–4.
Available at: http://www.kidney.org/atoz/pdf/anemia.pdf. Accessed November 10, 2012.
National Kidney Foundation. Iron and Chronic Kidney Disease: What You Need to
Know. Available at: http://www.kidney.org/atoz/pdf/11-100284_PatBro_IronDeficiency.pdf. Accessed November 10, 2012.
National Kidney Foundation. Iron needs in dialysis. Available at:
http://www.kidney.org/atoz/content/ironDialysis.cfm. Accessed November 10, 2012.
Contributed by Elaine M. Koontz, RD, LD/N
Review Date 11/12
R-0594