Renal anemia affects many patients with chronic kidney disease. Not only does it adversely affect patients’ quality of life, it worsens the course of kidney disease, increases the risk of cardiovascular events, and is associated with increased mortality. Unfortunately, it is still ignored in Poland …
More often than we think
Statistics in black and white show that chronic kidney disease (CKD) is, next to cardiovascular diseases, hypertension, diabetes and obesity, a civilization disease of the 1st century. According to epidemiological studies, CKD affects every tenth person in the world. In Europe, this applies to as many as one-eighth of the population. [XNUMX]
Mortality statistics are even more worrying. According to the results of the Global Burden of Disease study, CKD caused 2017 million deaths worldwide in 1,2 alone. Compared to 920 thousand. in 2007 this means an increase of 34 percent. Worse still, the disease is projected to become the fifth leading cause of premature death in the world over the next two decades.
Experts emphasize that CKD in Poland is an underdiagnosed disease. Out of 4,5 million Poles suffering from chronic kidney disease, only 5 percent. is under the care of Nephrology Clinics. The problem of failure to diagnose CKD is also associated with its complications, incl renal anemia, which affects the majority of patients in advanced stages of the disease and almost all chronic dialysis patients. Renal anemia is due to the decline in the ability of the kidneys to produce erythropoietin, which stimulates the marrow to produce red blood cells (erythrocytes), increased secretion of hepcidin (a hormone involved in regulating iron metabolism), and iron deficiency due to chronic inflammation.
From lack of energy to heart problems
Renal anemia it requires appropriate treatment in the early stages of CKD for several reasons. First, it places a heavy burden on the psychophysical health of patients. Its symptoms, such as constant fatigue, lack of energy while performing daily activities, headaches and dizziness, sleep problems and general depressed mood adversely affect the private and professional lives of patients. They are often the cause of sickness absence and a sense of social isolation.
Second, untreated nephrogenic anemia leads to many complications, including cardiovascular events. The relationship of CKD with cardiovascular diseases has been the subject of intensive research for years. Among about 30-50 percent CKD sufferers have symptoms of coronary artery disease or heart failure.
The high risk of cardiovascular diseases results from the frequent presence of both typical risk factors in this group of patients: old age, concomitant arterial hypertension, diabetes, dyslipidemia or obesity, as well as atypical risk factors, including anemia which, as kidney disease continues, leads to an unfavorable remodeling of the heart muscle (left ventricular hypertrophy), the onset of coronary artery disease and the subsequent development of heart failure. [2]
The interrelationship between anemia, heart failure and CKD is known as “cardio-renal anemia syndrome” (cardiorenal anemia syndrome). It’s kind of a vicious circle that in which one of the components intensifies the next. [3] Cardiorenal anemia syndrome develops a self-perpetuating triad that increases the risk of death if all three pathologies are present. The relative risk of death doubles in patients with anemia and CKD, and threefold in those with additional cardiovascular disease.
Moreover, in patients with chronic kidney disease, cardiovascular diseases resulting from disorders of the structure and function of the heart muscle and atherosclerotic changes in the vessels are manifested by more frequent strokes and peripheral vascular diseases.
To other complications renal anemia belong:
- hormonal disorders (menstrual disorders, deterioration of sexual function),
- disorders of the immune response,
- CKD progression,
- increased need for blood transfusions and immunization of patients.