Anemia of Chronic Kidney Disease (CKD)

Overview

• Patients with CKD often experience anemia.
• Several factors contribute to this condition.

Key Factors Contributing to Anemia of CKD

1. Relative Iron Deficiency

   • Caused by:
     • Blood loss
     • Increased oxidant levels
   • Pepsidin:
     • A hormone that sequesters iron in cells
     • Limits intestinal dietary iron absorption
     • Reduces serum iron availability

2. Shortened Erythrocyte Lifespan

   • Systemic inflammation affects erythrocyte survival.

3. Relative Erythropoietin Deficiency

   • Caused by:
     • Impaired oxygen sensing in the kidneys
   • Important pathophysiological mechanism leading to suppressed erythropoietin production.

Oxygen Sensing in the Kidneys

• Renal Erythropoietin Producing Cells:
  • Contain Hypoxia-Inducible Factors (HIFs)
  • Function:
    • Activated in low oxygen conditions to stimulate erythropoietin production.
    • Degraded when sufficient oxygen is detected.
• In CKD:
  • Damage to the kidneys disrupts the HIF oxygen sensing pathway.
  • Results in reduced erythropoietin production, contributing to anemia.

Conclusion

• Anemia in CKD is multifactorial, with significant roles played by iron deficiency, systemic inflammation, and impaired oxygen sensing.