Anemia, a common complication in patients with chronic kidney disease, has been shown to show that the overall prevalence of renal anemia is about 29% to 72%, and if the disease progresses to the stage of uremia, the incidence of anemia in patients with chronic kidney disease undergoing dialysis therapy is about 92% to 98%. So, how is renal anemia caused? Do I need iron supplementation? In daily life, what measures should be taken to cooperate with treatment? Let's solve your doubts now.
In patients with chronic kidney disease, anemia due to impaired renal function is called renal anemia. The main manifestations of patients are 3 categories, 1st, pale or yellowish, the color of the lips and eyelids is lightened, the skin is dry and wrinkled, the hair lacks luster, it is easy to fall out, the color of the nails also becomes lighter, and sometimes jaundice occurs. Second, partial eating, decreased appetite, weakened digestive function, malnutrition. Third, dizziness, palpitations and shortness of breath, irregular menstruation, bloating and diarrhea. Blood test results, hemoglobin levels are less than 120 g/L for women and less than 130 g/L for men. In addition, there are also abnormalities in serum ferritin, transferrin saturation, folic acid, vitamin B12 and other indicators.
After the diagnosis of renal anemia, experienced doctors will remind patients to pay attention to checking the water pipes in the home to see if there is any rust or paint loss of the water pipes, because after the problems of these water pipes, it will lead to excessive lead in tap water, and lead is a systemic toxin, which can cause functional damage to multiple organs and systems, and lead will accumulate in the body. The lead content of residents' drinking water should not exceed 0.01mg/L, in addition, it is also necessary to pay attention to the impact of paint, metal cans, car exhaust and so on. Studies have shown that the increase in lead content in tap water is related to the occurrence and severity of renal anemia, and after the kidney function declines, lead is more likely to accumulate in the body, thus aggravating renal anemia.
Chronic kidney disease leads to anemia, and the pathogenesis is complex. At present, the medical community believes that the main factor is related to erythropoietin EPO, because the red blood cells in our body will age and apoptosis every day, and need to be supplemented through bone marrow hematopoiesis, and EPO is a hormone that regulates erythrocyte production. EPO, 90% is produced by the kidneys, 10% by the liver and spleen, when the kidney function is impaired, the amount of EPO production will drop sharply. At the same time, a large number of harmful substances can not be excreted in time, will accumulate in the body, inhibit the hematopoietic function of bone marrow, and affect the life of red blood cells. In addition, malnutrition and bleeding are also related factors to anemia.
In recent years, scholars have discovered that hypoxia sensing systems, which play a key role in the synthesis and release of EPO, won the 2019 Nobel Prize in Physiology or Medicine. Studies have also found that renal anemia, manifested mainly by iron deficiency anemia, chronic inflammation and the action of hepcidin, can lead to impaired use of iron. Therefore, iron is an important raw material for the production of EPO and red blood cells. In dialysis patients, iron deficiency is more pronounced, with an increase in serum ferritin and a decrease in transferrin levels.
There are 4 main methods for the treatment of renal anemia. The first type, iron therapy, is currently recommended to increase hemoglobin levels through intravenous iron supplementation, which is more efficient, mainly using iron sucrose and iron dextran. The second type is the treatment of erythropoietic stimulators, including drugs such as daepostine and recombinant erythropoietin. The third is a new type of drug, mainly a small molecule low-oxygen inducible proline hydroxylase inhibitor roxapstat. The fourth type is hemodialysis and hemoperfusion therapy.
Patients with renal anemia, need to carry out dietary conditioning, for example, through food iron supplementation, it should be noted that heme iron in animal foods is easily absorbed by the human body, while non-heme iron in plant foods is not easy to be absorbed. Iron in red meat, the absorption rate is about 20%, the iron in red dates, the absorption rate is only 4%, if patients with renal anemia need to supplement 1000 mg of iron, they need to eat 2 tons of red dates, and 100 grams of duck blood, iron content of about 30 mg, the efficiency of iron supplementation is higher. Patients with renal anemia can also eat more vitamin C-rich foods, such as green leafy vegetables or kiwifruit, which can increase the absorption rate of iron by 2 to 3 times. In addition, patients with renal anemia should limit fat intake, the proportion of fat energy supply should not exceed 40% of the total amount, so as not to affect digestion and absorption or inhibit hematopoietic function, at the same time, avoid the intake of caffeine or tannic acid-rich foods, such as milk tea or coffee, so as not to reduce the absorption rate of iron.
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