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Anemia occurs when your blood does not have enough red blood cells in it. Normally, the kidneys send out a signal (a hormone—erythropoietin) that tells your body when to make new red blood cells. But if you have kidney disease, your kidneys may not be able to send this signal.

If you are anemic you may feel: tired, short of breath, trouble concentrating, rapid, irregular heartbeat, impotence, loss of appetite, feeling dizzy or lightheaded and constant feeling of being cold.

Most people with chronic kidney disease, and nearly all patients with End Stage Renal Disease who are on dialysis, have anemia, since the kidneys make and secret the hormone erythropoietin. This hormone is responsible for keeping a normal red blood cell count.

Most patients with anemia due to chronic kidney disease who are not yet on dialysis will receive erythropoietin as an injection—directly under the skin. Most patients with renal failure on dialysis will get the hormone during each treatment by intravenous injection into the return dialysis tubing. Most peritoneal (PD) patients will get erythropoietin by injection directly under the skin.

Erythropoietin is a hormone produced in the kidneys. It travels to the bone marrow to signal the marrow to produce red blood cells. The red blood cells carry oxygen to all the parts of the body for energy.

Epogen/Aranesp is a medicine that you receive in dialysis that causes your bone marrow to make red blood cells. The dose of Epogen/Aranesp is determined by your hemoglobin levels. Hemoglobin is a test for anemia that measure how much oxygen your body can carry. We want your hemoglobin level to be between 10.5-11.5g/dl. If your hemoglobin is less than 10g/dl your Epogen/Aranesp dose may be increased. If your hemoglobin is greater than 11.5 your Epogen/Aranesp level may be decreased or held.

In order for erythropoietin to work well, iron needs to be present to make red blood cells. Without iron fewer red blood cells are made. Most dialysis patients need to receive iron. Iron may be absorbed from foods you eat. Iron may be taken as a pill as directed or given in an intravenous injection during the dialysis treatment.

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