Are hematological changes caused by Chronic Kidney Disease (CKD)?

From the Guidelines

Yes, Chronic Kidney Disease (CKD) causes significant hematological changes, with anemia being the most common manifestation, as evidenced by the most recent study in 2021 1. As kidney function declines, the kidneys produce less erythropoietin, a hormone essential for red blood cell production in the bone marrow. This leads to normocytic normochromic anemia, which typically worsens as CKD progresses. Some key points to consider in the management of anemia in CKD patients include:

• Iron deficiency is a major contributor to anemia in CKD patients, and assessment of iron status is crucial, with measurement of ferritin and transferrin saturation being helpful, but requiring careful interpretation in the context of CKD 1.
• Treatment often includes erythropoiesis-stimulating agents (ESAs) such as epoetin alfa or darbepoetin alfa, along with iron supplementation to maintain adequate iron stores, with the goal of maintaining ferritin levels and transferrin saturation within target ranges 1.
• Beyond anemia, CKD patients may experience other hematological changes, including platelet dysfunction, leukocyte dysfunction, and coagulation abnormalities, which can increase the risk of bleeding, infection, and other complications 1.
• Regular complete blood count monitoring is essential for CKD patients to detect and manage these complications early, and to adjust treatment as needed to optimize outcomes 1. The most recent and highest quality study, from 2021, provides guidance on the management of iron deficiency anemia in adults, including those with CKD, and emphasizes the importance of careful evaluation and treatment of iron deficiency in these patients 1.

From the Research

Hematological Changes in CKD

Hematological changes are a common complication of Chronic Kidney Disease (CKD). The main hematological changes associated with CKD include:

• Anemia, which is a decrease in the number of red blood cells or the amount of hemoglobin in the blood 2, 3, 4
• Iron deficiency, which can be absolute or functional 2, 4
• Elevated hepcidin levels, which can lead to iron deficiency and anemia 2, 3, 4

Causes of Hematological Changes in CKD

The causes of hematological changes in CKD are diverse and complex. They include:

• Decrease in endogenous erythropoietin (EPO) production 3
• Absolute and/or functional iron deficiency 2, 3, 4
• Inflammation with increased hepcidin levels 2, 3, 4
• Blood loss, which can lead to absolute iron deficiency 4

Treatment of Hematological Changes in CKD

The treatment of hematological changes in CKD depends on the underlying cause. Treatment options include:

• Iron supplementation, which can be oral or intravenous 2, 3, 4
• Erythropoiesis-stimulating agents (ESAs), which can be used to stimulate red blood cell production 3, 5, 6
• Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), which are a new class of drugs that can increase EPO production and improve iron availability 3, 6

Management of Anemia in CKD

Anemia is a common complication of CKD and can be managed with:

• Screening for anemia during the initial evaluation for CKD 2
• Use of criteria to define iron deficiency, which are different for CKD patients compared to those with normal renal function 2
• Treatment with iron supplementation and/or ESAs 2, 3, 5, 6