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Stage 4 Chronic Kidney Disease and Diabetes: Why do I Have Anemia

Stage 4 Chronic Kidney Disease and Diabetes: Why do I Have AnemiaAnemia is a frequent complication of Stage 4 Chronic Kidney Disease caused by Diabetes. This article introduces the reason of anemia in these patients. Read on or chat with our free online doctor if you would like to talk directly.


Usually, anemia is defined by hemoglobin (Hb) concentration < 12g/dl for female and < 13.5g/dl for male.

In Diabetes and Stage 4 Chronic Kidney Disease patients, Hb concentrations usually are not routinely assessed. Decrease in Hb often occur before the onset of Overt Diabetic Nephropathy.


• Low levels of erythropoietin (EPO). Around 90% of the hormone EPO is produced by the kidneys. When the body senses low oxygen levels, it tells the kidneys to release epo. This hormone tells the bone marrow to make more red blood cells. More red blood cells in the bloodstream mean more oxygen can be transported. However, in Stage 4 Chronic Kidney Disease, the kidneys are severely damaged, they make less or little epo.

• Medicines. The use of medications in Diabetes treatment may adversely affect Hb production. These include metformin, fibrates, ACE inhibitors and thiazolidinediones.

• Systemic inflammation related with diabetic microvascular disease leads to the production of inflammatory mediators (like interleukins, tissue necrosis factor). These mediator blunt the effect of epo on the bone marrow.

• Malnutrition and deficiencies of iron, folate, and vitamin B12 may result in a reduction in Hb concentrations.

Depending on the causes of anemia in Stage 4 Chronic Kidney Disease and Diabetes, the doctor can make corresponding treatment plan to solve this problem. If you need personalized suggestions, feel free to email us at or leave a message in the below.

  • Tag: CKD symptoms
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