When kidney health changes, oxygen delivery can change too.

Anaemia means you have fewer healthy red blood cells or less haemoglobin — the protein in red blood cells that carries oxygen.

When kidney function declines, the kidneys make less erythropoietin (EPO) — a hormone that signals your bone marrow to make red blood cells. Less EPO can lead to fewer red blood cells and lower oxygen delivery to tissues.

Prepare for a conversation with your doctor See how CKD anaemia is treated

This page is for education only and not a substitute for medical advice.

The oxygen delivery pathway

1Kidney

Impaired kidney function reduces EPO production

2EPO signal

Less EPO signal is sent to bone marrow

3Bone marrow

Reduced stimulation of red blood cell production

4Red blood cells

Fewer red blood cells are produced

5Oxygen delivery

Less oxygen reaches body tissues

Not every anaemia is caused by CKD. Many other conditions can cause low haemoglobin. Diagnosis and treatment decisions should be made by a clinician.

Why CKD can cause anaemia

Reduced erythropoietin production

Damaged kidneys produce less EPO, leading to reduced stimulation of red blood cell production.

Source: DREAM-ND Phase III

Inflammation and higher hepcidin

Inflammation increases hepcidin, which reduces iron release from stores and limits iron availability.

Functional iron deficiency

Lower iron absorption and mobilisation can limit the iron available for red blood cell production.

Dialysis-related factors (when applicable)

Blood loss during dialysis and shorter red-cell survival can contribute to anaemia in people on dialysis.

Source: DREAM-D Phase III

What anaemia may feel like

Fatigue

Feeling unusually tired or lacking energy.

Reduced exercise tolerance

Getting tired more easily or needing to rest.

Shortness of breath

Breathlessness with activity or at rest.

Difficulty concentrating

Trouble focusing, “brain fog” or memory problems.

Reduced ability for everyday activities

Finding day-to-day tasks harder to complete.

Symptoms can be caused by many conditions and are not diagnostic. Talk to your doctor.

How clinicians assess CKD anaemia

Symptoms & history

Your doctor will ask about how you feel, medical history and treatments.

Blood tests

Haemoglobin (Hb) and complete blood count to confirm anaemia.

Iron status

Iron tests such as ferritin and transferrin saturation to assess iron availability.

Exclude other causes

Rule out blood loss, nutritional deficiencies, infection, malignancy or other conditions.

Ongoing monitoring

Regular follow-up to monitor response and adjust the plan.

Your clinician will interpret results in context and not as diagnostic alone.

Two care journeys

Person living with CKD and not receiving dialysis

Living with CKD, not on dialysis

Kidneys still filter blood but less effectively. Anaemia management focuses on preserving kidney function, treating causes, and maintaining iron and haemoglobin levels.

Learn about non-dialysis care Source: DREAM-ND Phase III

Receiving dialysis

Dialysis can contribute to anaemia through blood loss and shortened red-cell survival. Management is tailored to dialysis frequency and individual needs.

Learn about dialysis care Source: DREAM-D Phase III

Next steps

For patients & caregivers

Download a list of questions to help you have an informed conversation with your doctor.

Download questions

For healthcare professionals

Explore the HIF pathway and mechanisms relevant to CKD anaemia.

Explore the HIF pathway

Why it matters

Quality of life & physical function

Anaemia is linked to fatigue, reduced activity and poorer quality of life.

Cardiovascular workload & risk

Lower haemoglobin can increase the workload on the heart and is associated with cardiovascular risks.

Hospitalisation & morbidity

Anaemia in CKD is associated with higher rates of hospitalisation and medical complications.

CKD progression

Anaemia is associated with faster CKD progression in some people.

These are associations. Ask your clinician how these may relate to you.

Source: South Asia HIF-PHI Guideline

Treatment landscape

Iron replacement

Where iron deficiency is present, iron supplements may be used (oral or IV) to improve iron availability.

Erythropoiesis-stimulating agents (ESAs)

Injectable medicines that stimulate red blood cell production (e.g., EPO and related therapies).

Oral HIF-PH inhibitors

Medicines such as desidustat help increase your body’s natural EPO production.

Transfusion

Used in selected or rescue situations when anaemia is severe or symptoms are critical.

Treatment choice is individual and based on your clinical needs, test results and preferences.

Sources & evidence

South Asia HIF-PHI GuidelineContext on burden, quality of life and treatment landscape.DREAM-ND Phase IIIWhat the study introduction explains for people with CKD not on dialysis.DREAM-D Phase IIIWhat the study introduction explains for people receiving dialysis.Systematic review (NDD-CKD)Evidence must be read molecule by molecule; important outcome gaps remain.OXEMIA® (Desidustat) PIView approved indication and prescribing information.