Iron and CKD (Chronic Kidney Disease) - National Kidney Foundation

7/24/2019 Iron and CKD (Chronic Kidney Disease) - National Kidney Foundation

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Iron and ChronicKidney Disease:What You Need to Know


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NATIONAL KIDNEY FOUNDATION2

National Kidney Foundations

Kidney Disease OutcomesQuality Initiative

Did you know that the National KidneyFoundations Kidney Disease OutcomesQuality Initiative (NKF-KDOQI) devel-

ops guidelines that help your doctor andhealth care team make important deci-sions about your medical treatment? Theinformation in this booklet is based onthe NKF-KDOQI recommended guide-lines for anemia.

Stages of Chronic KidneyDisease

There are five stages of chronic kidneydisease. They are shown in the tablebelow. Your doctor determines your stage

of kidney disease based on the presenceof kidney damage and your glomerularfiltration rate (GFR), which is a measureof your level of kidney function. Your treat-ment is based on your stage of kidney

disease. Speak to your doctor if youhave any questions about your stage ofkidney disease or your treatment.

*Your GFR number tells your doctor how much kidney function you have.As chronic kidney disease progresses, your GFR number decreases.

Stages of Kidney Disease

Stage Description Glomerular Filtration Rate (GFR)*

1Kidney damage (e.g., protein inthe urine) with normal GFR

90 or above

2Kidney damage with milddecrease in GFR

60 to 89

3 Moderate decrease in GFR 30 to 59

4 Severe reduction in GFR 15 to 295 Kidney failure Less than 15


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If you have chronic kidney disease (CKD),

your body may be lacking an importantmineral called iron. The purpose of thisbooklet is to answer some common ques-tions about iron, and how important it is forpeople with CKD to have healthy iron levels.

What is iron?

Iron is a mineral needed for healthy bloodcells and for overall good health. Iron isfound in a wide variety of foods. You can

also get iron from supplements taken bymouth and from iron medicines prescribedby your doctor.

What does iron do?

Iron helps your body in many ways. Oneway is to help make red blood cells. Redblood cells carry oxygen from your lungs toall parts of your body, giving you the energyyou need for your daily activities (see picturebelow). The kidneys signal the body to make

enough red blood cells, and iron helps inmaking them healthy red blood cells.

Red blood cells carry oxygen to all parts of your body.


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What is CKD?

Chronic kidney disease (CKD) includesconditions that damage your kidneys anddecrease their ability to keep you healthy.In the early stages of CKD, symptoms areusually silentyou may not be aware that

your kidney function is reduced. If CKDgets worse and your kidneys can no longerproperly filter blood, waste products buildto high levels, making you feel sick. Thismay happen slowly over a long period

of time. People with CKD may developcomplications such as high blood pressure,anemia, weak bones and poor nutrition.Also, CKD increases your risk of havingheart and blood vessel diseases. If CKD

gets worse, it may eventually lead tokidney failure, which requires dialysis ora kidney transplant to keep you alive.CKD may be caused by diabetes, highblood pressure or other disorders.

Your kidneys make an important hormonecalled erythropoietin (EPO). EPO signalsyour body to make red blood cells. When

you have kidney disease, you may notbe able to make enough EPO, a problemthat causes your red blood cell count todrop and anemia to develop. Some peo-ple with CKD need a medicine called an

erythropoiesis-stimulating agent (ESA) to dothe work of EPO (see picture on page 5).

FACT


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The kidneys signal the body to make red

blood cells.

Early detection of CKD and timely treatmentcan often keep it from progressing. Seepage 2 for a table showing the stagesof CKD.

Why is iron important in CKD?

Many people with CKD develop anemiabecause their red blood cell count is toolow. Iron is important in making healthy red

blood cells. Therefore, ensuring enough ironis in the body helps to correct anemia. Ifyour kidney doctor prescribes an ESA foryou, you will need extra iron for the medi-cine to work at its best. This is because

your iron supply is used up faster if you aretaking an ESA medicine.

How much iron do I need?

Your body needs enough iron to reach a

healthy hemoglobinlevel. Iron and oxygenmake up hemoglobin, which is the partof the red blood cells that carries oxygen


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through your body. Therefore, measuringthe amount of hemoglobin in your blood isone way to know if your body has enough

iron. The normal hemoglobin level is 12.0for women and 13.5 for men.

How else is my iron level tested?

Two important blood tests can tell your

doctor if you have enough iron. Theyare called transferrin saturation(TSAT)and ferritin.

n Your TSAT level should be at least

20 percent.n Your ferritin level should be at least

100 ng/mL.

Your iron testing should be done everymonth until your hemoglobin target isreached. After that, testing every threemonths is recommended.

Iron is important in treating anemia.Without enough iron you will notreach and maintain your targethemoglobin level.

FACT


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How will I feel if my iron level

is low?If your iron level is low, you may have lowhemoglobin, which can cause you to:

n feel more tired than usual

n

feel weakern look pale

nfeel down or depressed

n feel short of breath with activity

nhave chest pain

n feel dizzy or light-headed

n feel numbness or coldness in yourhands and feet

nhave a faster heartbeat

See your health care provider as soonas you can if you are experiencing thesesymptoms. Write down how you feel,your allergies, medications, previousmedical procedures and other healthproblems. Discuss how you are feeling.

You may want to ask:

nDo I have enough iron?

nWhat can I do to feel better?

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What is the treatment for

low iron?If you have low iron and low hemoglobin,your doctor will develop a treatment planthat is right for you. One or more of the fol-lowing may be suggested:

n Increasing the iron in your diet by eat-ing foods rich in iron such as red meat,leafy green vegetables and eggs. Adietitian can help you plan meals toinclude foods that are good sources of

iron and other minerals, and are suit-able choices when you have CKD.

n Iron supplements by mouth as a tabletor liquid.

nA multivitaminand mineralsupplement thatcontains iron,vitamin B12and folic acid.

Ask your doc-tor, dietitianor pharmacist

Iron supplementstaken by mouth canaffect other medi-cines you may betaking. Talk to yourdoctor, dietitian or

pharmacist beforetaking iron tablets.

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how to choose a supplement suitable

for people with kidney disease.n Iron medicine given by injection into

a vein at your doctors office or clinic.

Where can I get more information?The moreyou knowabout ironand CKD,

the greaterthe likelihoodyou will havehealthy ironand hemoglo-

bin levels.

Seek advice from a pharmacist, your familydoctor, your kidney doctor or a dietitian. Askthese people for sources of information on

learning about iron.

Research is always being done to lookfor new medicines that can improve irondeficiency in people with CKD. Ideally,new treatments can make sure you have

enough iron, and can have long-lastingbenefits and few side effects. Talk toyour doctor about the availability ofnew iron treatments.

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Contact the National Kidney Foundation at

800.622.9010 to receive a free copy ofthese booklets or information about otherNKF resources. Make sure you indicate thebooklet number where shown. Some book-lets can be downloaded from the NKF

Web site www.kidney.org

n Are You at Increased Risk for ChronicKidney Disease?(English: 11-10-1814;Spanish: 11-10-1816)

n

Anemia and Chronic Kidney Disease,Stages 14(English: 11-10-0283;Spanish: 11-10-0287)

n Diabetes and Chronic KidneyDisease, Stages 14(English:

11-10-0209; Spanish: 11-10-0240)www.kidney.org/atoz/atozcopy.cfm?pdflink=diabetes.pdf

n Nutrition and Early Kidney Disease:Are You Getting What You Need?

(Stages 14)(English: 11-50-0114)n Your Kidneys: Master Chemists

of the Body(11-10-0103)www.kidney.org/atoz/atozcopy.cfm?pdflink=masterchemists.pdf

You can also contact your local NKF officefor information about CKD and for upcom-ing community CKD events, includingfree kidney health screenings. Visitwww.kidney.orgto locate your nearest

NKF office.


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NOTES


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More than 26 million American adults and thousands of Americanchildren have chronic kidney disease. Most do not know they have this

condition. Further, millions of people with diabetes, hypertension andother diseases do not realize they are at risk for developing kidneydisease. The National Kidney Foundation, a major voluntary healthorganization, seeks to prevent kidney and urinary tract diseases, improvethe health and well-being of individuals and families affected by thesediseases and increase the availability of all organs for transplantation.Through its Affiliates and Divisions nationwide, the Foundation conductsprograms in research, professional education, patient advocacy and

community services, public education and organ donation.

The National Kidney Foundation gratefully

acknowledges the support of

National Kidney Foundation30 East 33rd StreetNew York, NY 10016800.622.9010

www.kidney.org

Tambin disponible en espaol con el nmero de pedido 11-10-0282 2008 National Kidney Foundation, Inc. All rights reserved. 11-10-0284

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Iron and CKD (Chronic Kidney Disease) - National Kidney Foundation

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