Pathophysiology

The primary cause of anemia in patients with CKD is a decrease in EPO production. With normal kidney function, as Hgb, hematocrit (Hct), and tissue oxygenation decrease, the plasma concentration of EPO increases exponentially. As the number of functioning nephrons decrease, EPO production also decreases. Thus, as Hgb, Hct, and tissue oxygenation decrease in patients with CKD, plasma EPO levels remain constant within the normal range, but low relative to the degree of hypoxia present. The result is a normochromic, normocytic anemia.

Several other factors also contribute to the development of anemia in patients with CKD. Uremia, the accumulation of toxins that results from declining kidney func-

tion, decreases the lifespan of RBCs from a normal of 120 days to as low as 60 days in patients with stage 5 CKD. Iron deficiency and blood loss from regular laboratory testing and hemodialysis also contribute to the development of anemia in patients with CKD.

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