It has been seen that people suffering from kidney failure invariably have anemia. This is because the kidneys are responsible for manufacturing a hormone known as erythropoietin. This hormone stimulates the bone marrow to manufacture red blood cells containing hemoglobin. When a person suffers from kidney failure, the kidneys either do not produce the hormone or they not produce adequate amounts of the hormone. Hence, this affects the production of red blood cells, leading to anemia.

When a person is diagnosed with kidney failure, one of the first tests that a doctor will request for is the complete blood count. With the help of this test, the doctor will determine what percentage of blood contains RBCs. This percentage is also known as hematocrit level. Once the hematocrit level is determined, the doctor can figure out the hemoglobin level, which is about 1/3rd that of hematocrit level.

In patients suffering from kidney failure, anemia begins to develop during the initial stages of the disease, when the kidneys are still functioning but not optimally. As the disease progresses, the anemia also becomes worse. Usually, when the kidney disease reaches the final stage, the person will require a transplant or dialysis. It is important to note that not all patients suffering from kidney failure will suffer from anemia.

If the patient's kidneys are still working, though not optimally, and the patient's complete blood count shows lowered levels of hematocrit, then the person is suffering from anemia due to reduced production of erythropoietin hormone. In such a case, the doctor will ask for another blood test to identify the glomerular filtration rate. Once this rate is determined, the doctor will begin the treatment.

People suffering from anemia and kidney failure require artificially synthesized erythropoietin. This hormone is given to the person in the form of an injection 2 or 3 times in a week. Usually, the hormone is injected epidermally. However, patients on hemodialysis are given the hormone in injection form intravenously. The latter is more expensive and may not always prove to be effective in rectifying anemia.
According to the US FDA, people with kidney failure and receiving artificial erythropoietin should have a hemoglobin count of 10 to 12 gm/dl. However, some studies have shown that when the hemoglobin count in such patients goes up to 12 gm/dl, they have a higher chance of suffering from a heart attack, stroke or heart failure.

In addition, the patients are also put on iron supplements, as low levels of iron will make the erythropoietin injections useless and the patient will continue to suffer from anemia. As kidney failure patients do not benefit from taking iron supplements orally, usually the iron is given to them intravenously.

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