Why does chronic kidney disease cause anemia?

Damaged kidneys make less erythropoietin (EPO), the hormone that tells the bone marrow to produce red blood cells, so the body makes fewer of them. Low iron and the inflammation that often accompanies kidney disease add to it, and red blood cells may not survive as long. Together these make anemia increasingly common as CKD advances.

Can anemia of CKD be treated?

Yes, and effectively. Options include iron (by mouth or, when needed, given another way), medications that help the body make red blood cells (ESAs), and, for some patients, a newer oral medicine. Your kidney team tailors the plan to your blood counts and iron levels and adjusts it over time.

Is there a pill for anemia of kidney disease?

Yes — a newer oral class called HIF-PH inhibitors. In the US, the available option (daprodustat) is currently approved for adults on dialysis, as an alternative to injection-based treatments. It's the first new approach to this kind of anemia in over 30 years. Your doctor can say whether it applies to you.

Is anemia common with kidney disease?

Yes, especially in the later stages, as the kidneys make less of the hormone that supports red-blood-cell production. It's common enough that checking blood counts is a routine part of kidney care.

What hemoglobin level counts as anemia?

In general, anemia is defined as a hemoglobin below about 13 g/dL in men and below about 12 g/dL in women, though your nephrologist looks at the whole picture, not a single number. When treatment is needed, the goal is usually to ease symptoms and avoid the risks of very low — or overly high — levels, rather than to chase a specific target.

Will treating anemia make me feel better?

Often, yes. Many people notice more energy, less breathlessness, and clearer thinking once anemia is corrected. Beyond feeling better, treating it also eases strain on the heart — which is why it's a routine part of good kidney care, not an afterthought.

Do I need iron infusions for anemia of CKD?

Not always. In earlier-stage kidney disease, iron is often taken as tablets. When tablets aren't enough or aren't well absorbed — more common in advanced CKD or on dialysis — iron may be given another way in a care setting. Your team decides based on your iron studies and how you respond.

Anemia and Chronic Kidney Disease: Causes & Treatment

Q: What are the symptoms of anemia in kidney disease?

Fatigue, weakness, shortness of breath, feeling cold, pale skin, dizziness, headaches, and trouble concentrating. They usually develop slowly and are easy to dismiss as just getting older or being busy — which is one reason a simple blood test matters.

Q: How is anemia of CKD diagnosed?

With simple blood tests. A complete blood count measures your hemoglobin (how anemic you are), and iron studies — ferritin (stored iron) and TSAT (iron available for use) — show whether low or poorly used iron is part of the picture. These guide which treatment will help most.

Anemia of Chronic Kidney Disease

A clear, current guide to anemia of CKD — why damaged kidneys lower your red blood cells, the symptoms that creep up slowly, how it's diagnosed, and today's treatment options, including a new oral medicine. From metro Atlanta's largest kidney-care team.

Medically reviewed by a Georgia Nephrology physician · Last updated July 2026

What is anemia of CKD?

Anemia means your blood carries too few healthy red blood cells — the cells that ferry oxygen from your lungs to the rest of your body. When there aren’t enough of them, tissues get less oxygen, and you feel it as tiredness, weakness, and breathlessness.

Anemia is one of the most common complications of chronic kidney disease. It becomes more likely as kidney function declines, and it’s important precisely because it’s both common and very treatable — left alone it can wear you down and strain your heart, but addressed well, it often helps people feel noticeably better.

Common

Anemia grows steadily more common as CKD advances — and in its later stages, most people develop some degree of it.

Why does kidney disease cause anemia?

Healthy kidneys do far more than filter. Among their quieter jobs, they make a hormone called erythropoietin — usually shortened to EPO — that signals the bone marrow to produce red blood cells. When the kidneys are damaged, they make less of it, so the marrow makes fewer red cells. That shortfall is the main reason CKD causes anemia, and several other factors usually pile on:

Less erythropoietin

The central cause — damaged kidneys make less of the hormone that tells the marrow to build red blood cells.

Low or trapped iron

Iron is the raw material for red cells. In CKD it’s often low, or present but hard for the body to use.

Inflammation

The low-grade inflammation common in kidney disease interferes with how the body absorbs and releases iron.

Shorter red-cell life

In kidney disease, red blood cells tend not to survive as long, so the body has to replace them faster.

Sometimes low vitamin B12 or folate plays a part too. The mix differs from person to person, which is part of why treatment isn’t one-size-fits-all — and why your kidney team checks more than a single number.

What are the symptoms of anemia in kidney disease?

Because red blood cells carry oxygen, having too few can leave you feeling:

Tired and weak, with less energy than usual — often the first thing people notice.
Short of breath, especially with activity that didn’t used to wind you.
Cold, particularly in the hands and feet.
Pale, in the skin, lips, or inside the lower eyelids.
Light-headed or headachy, or unusually foggy and hard to concentrate.

These come on gradually, which is exactly why they’re so easy to dismiss as “just getting older” or “being busy.” If you have CKD and feel worn down, it’s worth mentioning — anemia is a common, fixable reason, and a simple blood test can check for it.

How is anemia of CKD diagnosed?

Diagnosing it is straightforward, and it usually rides along with the blood work you already have for kidney care:

A complete blood count (CBC), which includes your hemoglobin — the protein in red cells that carries oxygen, and the main measure of how anemic you are.
Iron studies — chiefly ferritin (a marker of stored iron) and TSAT, transferrin saturation (how much iron is actually available for the marrow to use). Together they show whether low or poorly used iron is part of the problem.

Because CKD-related anemia usually traces back to low erythropoietin and iron, these tests both confirm it and point to the right treatment. Your nephrologist looks at the full picture rather than any single value, and may add other tests — such as B12 or folate — when something doesn’t fit the usual pattern.

The goal isn’t to chase a perfect number. It’s to relieve symptoms, ease strain on the heart, and avoid the risks at both extremes — too low, and too high.

Why is anemia worth treating?

Anemia isn’t just about feeling tired, though that alone is worth addressing. Left untreated, it makes the heart work harder to move oxygen around the body, which adds strain over time — a meaningful concern, since people with CKD are already at higher risk of heart problems. It’s also linked with more hospitalizations and a poorer quality of life.

The flip side is the hopeful part: treating anemia well often helps people feel genuinely better — more energy, less breathlessness, clearer thinking — while easing that hidden load on the heart. That’s why it’s a routine part of complete kidney care, not an afterthought.

How is anemia of CKD treated — including what’s new?

Treatment aims to help your body make and keep enough healthy red blood cells, matched to what’s actually driving your anemia. Depending on your situation, your kidney team may use:

Iron, when iron is low or poorly used. It’s often taken by mouth in earlier-stage CKD; when tablets aren’t enough or aren’t well absorbed — more common in advanced kidney disease or on dialysis — iron can be given another way in a care setting.
Erythropoiesis-stimulating agents (ESAs), medications that do the job the kidneys’ own EPO no longer does — prompting the marrow to make red blood cells. They’ve long been the mainstay for more significant anemia and are usually given by injection.
A newer oral option (HIF-PH inhibitors). For the first meaningful innovation in this area in over 30 years, an oral medication — in the US, currently approved for adults on dialysis — helps the body make more of its own EPO and use iron better, offering an alternative to injections for some patients.
Vitamin B12 or folate, if a deficiency is contributing, and rarely a blood transfusion when anemia is severe.

Feeling tired with kidney disease is just something to live with.

Often it’s anemia — a specific, treatable cause. Correcting it frequently restores a lot of that lost energy.

Treating anemia always means needles and infusions.

Not necessarily. Iron is often a tablet, and a newer oral medicine is now an option for some patients.

If iron is the fix, I should just take a lot of it.

More isn’t better. Iron is matched to your blood and iron studies — too much carries its own risks, so it’s monitored.

More red blood cells are always better, so push the numbers high.

Aiming too high carries real risks. The goal is to ease symptoms and protect the heart, not to maximize the count.

Which approach fits you depends on your hemoglobin, your iron studies, your stage of kidney disease, and your other conditions — which is part of what a nephrologist sorts out. This page is about understanding the condition and its options; the right plan is always an individual conversation with your kidney team.

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When anemia is checked and managed

Because anemia tracks with kidney function, your nephrologist watches for it as part of routine care rather than waiting for symptoms — checking blood counts and, when needed, iron levels at regular intervals, more often in advanced CKD and on dialysis. Catching it early means it can be treated before it drags down your energy or strains your heart.

Anemia is also closely connected to the other ways advanced kidney disease affects the body, such as the bone and mineral changes of CKD-MBD. Managing them together, as one plan, is the heart of good CKD management — and it’s why keeping your kidney care in one place matters. The team that knows your kidneys is the same team keeping an eye on your blood counts over time.

One of the things we watch for, as standard.

Anemia is one of the things we watch for and treat as part of complete kidney care. Georgia Nephrology's physicians monitor blood counts and iron levels and manage anemia alongside the rest of your kidney health, across our 9 metro-Atlanta offices, several with on-site labs.

Because your care stays in one place — and because our physicians provide medical direction and care at more than 30 dialysis centers across metro Atlanta — the team treating your kidney disease is the same team keeping an eye on your blood counts through every stage.