Living with CKD,
not on dialysis
Focus is on slowing kidney decline, identifying and treating the cause of anaemia, and using medications and iron when needed.
Learn more about non-dialysis careCKD Anaemia reference: Badura, K., Janc, J., Wąsik, J., Gnitecki, S., Skwira, S., Młynarska, E., Rysz, J., & Franczyk, B. (2024). Anemia of Chronic Kidney Disease—A Narrative Review of Its Pathophysiology, Diagnosis, and Management. Biomedicines, 12(6), 1191. https://doi.org/10.3390/biomedicines12061191
Why CKD can cause anaemia
iNot every anaemia is caused by CKD. Other conditions can cause anaemia too.
Only your doctor can find the exact cause.
1 Reduced erythropoietin production
Damaged kidneys may produce less erythropoietin (EPO), a hormone that tells the bone marrow to make red blood cells.
2 Inflammation & higher hepcidin
Inflammation can raise hepcidin levels. Hepcidin blocks the release and absorption of iron needed to make red blood cells.
3 Functional iron deficiency & reduced absorption
Iron may be present in the body but is not available for red blood cell production. Absorption of iron from food may also be reduced.
4 Dialysis-related blood loss & shortened red-cell survival
Blood can be lost during dialysis. Red blood cells may also have a shorter lifespan in CKD.
Sources: DREAM-ND Phase III trial, DREAM-D Phase III trial, South Asia HIF-PHI guideline, Systematic review & meta-analysisView source details
CKD Anaemia symptoms reference: Tonelli M, Berns J, Bozkurt B, et al. KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease (CKD). Kidney International, 109, S1–S99.
What anaemia may feel like
FatigueFeeling unusually tired or lacking energy.
Reduced exercise toleranceGetting tired or short of breath with activity.
Shortness of breathBreathlessness during daily tasks or even at rest.
Difficulty concentratingTrouble focusing or remembering things.
Reduced ability to do everyday tasksHarder to perform routine activities.
iThese symptoms can be caused by many conditions. They are not diagnostic. Please consult your doctor.
Why it matters
- Quality of life & physical function
Anaemia can reduce energy, physical function and overall quality of life.
- Cardiovascular workload & risk
Anaemia can increase the workload on the heart and is associated with higher cardiovascular risk.
- Hospitalisation & morbidity
Anaemia is linked with more hospital visits and other health complications.
- Possible relationship with CKD progression
Severe or presistent anaemia may be associated with faster decline in kidney function.
iThese associations observed in studies. Treating anaemia may help, but outcomes depend on many factors.Source: South Asia HIF-PHI guidelineSee guideline context
How clinicians assess CKD anaemia
- 1Symptoms & history
Understanding your symptoms, medical history and medications.
- 2Haemoglobin / CBC
Blood tests to measure haemoglobin and other blood counts.
- 3Iron status
Checking iron stores (ferritin) and availability (transferrin saturation) when needed.
- 4Rule out other causes
Excluding blood loss, nutritional deficiency, infection, malignancy or other causes.
- 5Ongoing monitoring
Regular checks to see how you are responding to treatment.
Two care journeys
Anaemia care is different depending on whether you are on dialysis.
Living with CKD,
Receiving dialysis
Anaemia management also considers dialysis factors like blood loss during treatment and removal of toxins.
Learn more about dialysis careTreatment landscape
Your doctor will decide the best approach for you based on your health, test results and preferences.
- Iron replacement (oral or IV) when iron is low
- Erythropoiesis-stimulating agents (injectable)
- Oral HIF-PH inhibitors (e.g., desidustat)
- Transfusion in selected / rescue situations
Treatment choice is individual and clinician-led.
Benefits and risks should be discussed with your doctor.
Source: Systematic review & meta-analysis of HIF-PHIs in CKD anaemiaReview the systematic evidence
Take charge of your health
Download a helpful checklist of questions to ask your doctor
about CKD anaemia.
Want to understand the science?
Explore how the hypoxia-inducible factor (HIF) pathway
helps in making red blood cells.