Anemia during dialysis

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Specializes in Geriactrics, Pediatrics.

I have a question for dialysis nurses or nurses who are familiar with dialysis. When my husband was on dialysis (he is now deceased) he stayed anemic. He couldn't take the iron shots or take iron by mouth because it caused him to have an allergic reaction to it. This is turn caused pica whereby he craved ice, normal for folks with anemia. Wouldn't have been a problem except it put too much fluid on him and it couldn't be pulled off resulting in CHF which is what caused his death in the end. For a while I blamed myself and then wanted to blame the doctors but eventually realized that it was not one's fault but I just wanted to know what you do in a case like that. He died 11 years ago and I just have never been able to catch anyone to ask that question. I am at peace with it now and friends with his doctors.

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My condolences on the loss of your husband. Personally, I am a beyotch that would remain angry with the provider.

Kidney failure leads to the loss of erythropoietin ,an essential hormone for red blood cell production. Iron supplementation is not the the treatment. Iron will not help, if there is no red blood cell available to bind to. Epogen is the treatment.

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Specializes in Geriactrics, Pediatrics.

He did get the Epogen but it wasn't enough. He stayed anemic, always had low Hgb and Hct. He craved ice. They tried to give him the iron in injections but it always caused a reaction.

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He did get the Epogen but it wasn't enough. He stayed anemic, always had low Hgb and Hct. He craved ice. They tried to give him the iron in injections but it always caused a reaction.

When patients on dialysis can not take iron, get epo but still anemic it is up to the doctor to decide if they want the pat to be transfused with blood on occasions, which requires to go to the hospital as the do not give blood in the chronic unit.

Having said that, they usually accept a lower Hb and Hkt for dialysis patients and doctors order transfusions only if really needed for a variety of reasons.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

He could have suffered a condition whereby his body did not respond and use the epogen as it should. That could be a reason for why he was so chronically anemic. Some people respond poorly to epogen and just stay anemic. These days, we also use a drug called Mircera which some folks are responding well to.

Also did he suffer liver problems? Could be another complication that led to chronic anemia....

Can't say for sure all that was going on with him but I suspect hyporesponsiveness in his case. I am so sorry for your loss.

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My condolences on the loss of your husband. Personally, I am a beyotch that would remain angry with the provider.

Kidney failure leads to the loss of erythropoietin ,an essential hormone for red blood cell production. Iron supplementation is not the the treatment. Iron will not help, if there is no red blood cell available to bind to. Epogen is the treatment.

Ummm, errrr....

The statement "Iron will not help, if there is no red blood cell to bind to" is misleading.

Renal patients are a different beast. In true iron deficiency, which renal patients are prone to for a number of reasons including malabsorption in the GI tract and routine blood loss via dialysis itself, attaining the proper balance of iron in conjunction with EPO tx is essential. We can throw all the EPO at a patient with iron deficiency we want, and we might as well spit into the wind.

Impaired Iron mobilization (from "Iron Blockade" and suboptimal transferrin) in renal patients is a big deal, too.

This is why we are constantly monitoring for iron homeostasis in patients receiving EPO/ESA's.

Mechanisms of Anemia in CKD

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Specializes in Geriactrics, Pediatrics.

He didn't have any liver problems. Just was always a non-compliant diabetic who paid the ultimate price.

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