What are the causes of anemia and what is the prevalence in cases of chronic kidney disease (CKD)?

Updated: Oct 26, 2020
  • Author: Pradeep Arora, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Normochromic normocytic anemia principally develops from decreased renal synthesis of erythropoietin, the hormone responsible for bone marrow stimulation for red blood cell (RBC) production. The anemia starts early in the course of the disease and becomes more severe as viable renal mass shrinks and the GFR progressively decreases.

Using data from the National Health and Nutrition Examination Survey (NHANES), Stauffer and Fan found that anemia was twice as prevalent in people with CKD (15.4%) as in the general population (7.6%). The prevalence of anemia increased with stage of CKD, from 8.4% at stage 1 to 53.4% at stage 5. [16]

No reticulocyte response occurs. RBC survival is decreased, and bleeding tendency is increased from the uremia-induced platelet dysfunction. Other causes of anemia in CKD include the following:

  • Chronic blood loss: Uremia-induced platelet dysfunction enhances bleeding tendency
  • Secondary hyperparathyroidism
  • Inflammation
  • Nutritional deficiency
  • Accumulation of inhibitors of erythropoiesis

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