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Iron and EPO for Anemia

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blood cells


Treatments for Anemia

Anemia is a shortage of oxygen-carrying red blood cells that can happen with chronic kidney disease. You can learn more about symptoms of anemia by reading Symptoms of Kidney Disease.

The good news is, there are treatments that can help give you back some of your energy: iron and EPO.

diagram showing how iron is used in the bones, kidneys, and blood cells


How Your Body Makes Red Blood Cells

Your body needs both iron and the hormone erythropoietin (EPO) to make red blood cells. Iron is a building block for red blood cells. Your bone marrow is a red blood cell factory. EPO tells your bone marrow when it is time to make more red blood cells. It’s the switch that turns on the factory.

Since healthy kidneys make EPO, you may not have enough EPO if your kidneys don’t work as well as they should. Your doctor may prescribe both iron and EPO if you have anemia.

iron supplement tablets and IV


Iron Supplements by Mouth or IV

Your doctor may prescribe iron for you if the iron levels in your blood are too low. In most cases, this will be in the form of pills. Pills may not be absorbed well by your gut. Be sure to keep iron pills—and ALL of your other medicines—in bottles with childproof lids* if children come to your home. Each year, children are poisoned by medicines and some die.

If iron pills don’t give you enough iron, your doctor may prescribe iron to be given to you in a vein through an IV. This can “fill up your tank” much faster. You would need to come into the clinic for an hour or two for a nurse to give you iron.

*We all know that prescription medicines can cause harm if they are used the wrong way. But over–the-counter medicines can poison children, too! Keep ALL medicines in childproof bottles if there is any chance that a child could reach them.

EPO vial


EPO Treatment for Anemia

The other common treatment for anemia in people who have kidney disease is a manmade form of erythropoietin (EPO). EPO helps you make more of your own red blood cells. EPO must be injected under the skin or into a vein—there is no pill form. If you need EPO and have chronic kidney disease, you may need to come to a clinic visit to get it or learn to give it yourself.

If your kidneys fail and you do dialysis in a center, you will most likely get your EPO during your treatments. Ask what your dose is so you can track this.

warning triangle


FDA Warning about EPO

The U.S. Food and Drug Administration (FDA) has placed a “Black Box Warning” on EPO. The warning was added after some researchers found a higher risk of strokes and heart attacks in people with kidney disease when too much EPO was used.

But, having anemia that is not treated can also harm you. Anemia can make it hard to have the energy to get through each day and do the things you want to do. Your doctor will use the lowest dose of EPO possible. The goal is keep your red blood cell level high enough that you don’t need blood transfusions. Talk with your doctor about the benefits and risks of EPO.

bag of blood


Blood Transfusions Make It Harder to Get a Transplant

If your kidneys fail and you want a kidney transplant, each blood transfusion you get could make that harder. Blood is a living substance. It has immune cells from the blood donor that may react with your own blood. Most people don’t need transfusions. Good anemia treatment with iron and EPO can help you avoid them, too. To learn more about transplants, visit the Treatment Room.


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