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    Old 02-20-2009, 07:22 PM   #1
    flowergirl2day
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    Anemia of chronic disease/(chronic) inflammation

    What are the differences between anemia of chronic disease/chronic inflammation and anemia secondary to chronic kidney disease? How could an individual with chronic inflammation, chronic kidney disease and an iron deficiency determine the type of anemia he/she has? Is there a way to make this distinction through labwork? Things could get somewhat complicated if the anemia was an end result of several abnormalities.

    The text I read mentioned that the anemia of chronic disease/inflammation and anemia secondary to chronic kidney disease share some characteristics, without being specific. I am surprised to learn that they are two distinct conditions.

    thank you,
    flowergirl

     
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    Old 02-26-2009, 08:26 PM   #2
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    Re: Anemia of chronic disease/(chronic) inflammation

    Quote:
    Originally Posted by flowergirl2day View Post
    Hello FG! That's a fully loaded question('s). Hope you are doing well.

    What are the differences between anemia of chronic disease/chronic inflammation and anemia secondary to chronic kidney disease?
    Anemia of Chronic disease is when you have inflammation, cancer, autoimmune diseases, and such that result in anemia. Usually, they are mild to moderate and when treated the anemia may be resolved or kept at mild levels.

    Anemia secondary to chronic kidney disease is when anemia is a result of just that; chronic kidney disease (CKD), EPO's and then there is iron deficiency that can coexist on top of that.


    How could an individual with chronic inflammation, chronic kidney disease and an iron deficiency determine the type of anemia he/she has? Is there a way to make this distinction through labwork?
    The most common cause of anemia in patients with CKD is 1st EPO deficiency and 2nd iron deficiency. Many people that have CKD don't eat red meat for various reasons and may develop IDA. IDA can also be a result of blood loss through periods, GI tract and malabsorption syndromes.

    Iron levels should be checked by testing the T-Sat transferrin saturation, and ferritin stores. If either is low, then anemia may respond to oral iron or IV iron therapy.

    Further tests would include reticulocytes aka, retic count, B12, and folate. B12 and folate are required to make new RBC's and can also become deficient in patients with CKD if they do not eat a well balanced diet. Even another reason for anemia.

    The retic count tells the % of young red blood cells in your blood, which can sometimes distinguish the anemia cause whether due to inadequate production of RBC's or due to loss of RBC's. Most CKD patients will have a low reticulocyte count, reflecting a low production rate of red blood cells due to the ~deficient production~ of EPO by the diseased kidneys.


    Things could get somewhat complicated if the anemia was an end result of several abnormalities.
    Precisely, this is why they call it complicated anemia, when there are multiple causes.

    The text I read mentioned that the anemia of chronic disease/inflammation and anemia secondary to chronic kidney disease share some characteristics, without being specific. I am surprised to learn that they are two distinct conditions.

    thank you,
    flowergirl
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    Old 02-26-2009, 11:40 PM   #3
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    Re: Anemia of chronic disease/(chronic) inflammation

    flflowergirl,

    thank you for taking the time to answer my post. I thought I had the ferritin levels figured out - normal or elevated in anemia of chronic disease, low in an iron deficiency anemia. My ferritin was quite low-6- when last measured 7 months ago. I am not on any iron supplements so the ferritin could be even lower now.

    I also thought that anyone with anemia who has a chronic disease -including chronic kidney disease- had anemia of chronic disease, or a combination of two or more types of anemia. I now know that isn't the case at all and chronic kidney disease leads to a unique type of anemia, quite often a combination of several factors. (You can tell I discussed this with my nephrologist very briefly ) I wish there was more time to spend discussing these issues. They are not very important though compared to others. Interestingly, in this situation, ferritin levels are seldom used to assess the iron stores. I am told that the ferritin levels are deceiving and more often than not inaccurate. I won't begin to guess why that might be so. Perhaps because in chronic (and other) types of kidney disease there's so much going on?

    I do know that serum ferritin protein is an acute phase reactant. It becomes elevated in people with autoimmune inflammatory diseases. These elevated ferritin levels are a reflection of the disease, not the actual iron status. When such a person is anemic, serum ferritin is unreliable. Active infection resulting in elevated CRP & ESR levels (which I also have) will also increase ferritin levels.
    When the time comes, I will receive the EPO & iron treatments and the anemia will be corrected. I was told not to worry about it - my iron status along with other labs will be monitored regularly.
    If I learn more about these issues, I will post it here. Thank you once again.

    flowergirl

     
    Old 03-07-2009, 07:34 PM   #4
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    Re: Anemia of chronic disease/(chronic) inflammation

    Hi,

    I've just read in a huge Cardiovascular Medicine book that an oral iron therapy does not do anything for people with chronic kidney disease. (That might explain why my doctor had said I could take iron supplements....IF I WANTED TO....) I wish our doctors were more forthcoming!

    Apparently, iron supplements won't replete the iron stores, which is why people with CKD require an intravenous iron on regular basis - otherwise the response to the EPO therapy will NOT be adequate.
    Anemia of chronic kidney disease - a.k.a. anemia of chronic kidney failure - is supposed to be extremely common. Are there any people on this board who have it? I don't even know anyone with a kidney disease, with or without anemia!

    flowergirl

     
    Old 03-07-2009, 09:44 PM   #5
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    Re: Anemia of chronic disease/(chronic) inflammation

    Quote:
    Originally Posted by flowergirl2day View Post
    flflowergirl,

    thank you for taking the time to answer my post. I thought I had the ferritin levels figured out - normal or elevated in anemia of chronic disease, low in an iron deficiency anemia. My ferritin was quite low-6- when last measured 7 months ago. I am not on any iron supplements so the ferritin could be even lower now.

    I also thought that anyone with anemia who has a chronic disease -including chronic kidney disease- had anemia of chronic disease, or a combination of two or more types of anemia. I now know that isn't the case at all and chronic kidney disease leads to a unique type of anemia, quite often a combination of several factors. (You can tell I discussed this with my nephrologist very briefly ) I wish there was more time to spend discussing these issues. They are not very important though compared to others. Interestingly, in this situation, ferritin levels are seldom used to assess the iron stores. I am told that the ferritin levels are deceiving and more often than not inaccurate. I won't begin to guess why that might be so. Perhaps because in chronic (and other) types of kidney disease there's so much going on?

    I do know that serum ferritin protein is an acute phase reactant. It becomes elevated in people with autoimmune inflammatory diseases. These elevated ferritin levels are a reflection of the disease, not the actual iron status. When such a person is anemic, serum ferritin is unreliable. Active infection resulting in elevated CRP & ESR levels (which I also have) will also increase ferritin levels.
    When the time comes, I will receive the EPO & iron treatments and the anemia will be corrected. I was told not to worry about it - my iron status along with other labs will be monitored regularly.
    If I learn more about these issues, I will post it here. Thank you once again.

    flowergirl
    Hi flowergirl, I am anemic and I was not taking my iron for many many years. It wasn't until I begin loosing my hair when I realized how serious this really is.lol I know it took something vain for me to realize this you would think the dizzy spells would have been the slammer but no it was when I begin loosing hair!

    I do not have chronic kidney disease. Although I have had kidney infections in the past, but it has had no effect on my anemia and I haven't had a kidney infection in many years. Wish I could be of more help though. I also wished I hadn't taken so many years before I realized how serious this is.

    Currently, I supplement daily iron, vitamin-C, B100, B6, D and fish oil. I am 44 years of age.

     
    Old 03-08-2009, 01:08 AM   #6
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    Re: Anemia of chronic disease/(chronic) inflammation

    Hi
    my mother inlaw is diabetic which can affect the kidneys ...She has poor kidney function and has been told she may have to have dialysis and is also anemic of unknown origins.......Interesting

    Last edited by robinegg; 03-08-2009 at 01:09 AM.

     
    Old 03-08-2009, 03:32 PM   #7
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    Re: Anemia of chronic disease/(chronic) inflammation

    Thank you very much for your replies, Blkqwn and Rainbow's End.

    Blkqwn, I hope the iron supplements have helped replete your iron stores and that your hair has grown back! Dizziness can have many causes - such as fluctuations in blood pressure-, or be a side effect of medication, so that not everyone will associate it with anemia. Glad you've (finally!!!)decided to treat yours! Good luck to you!

    Rainbow's End, diabetes is the #1 cause of ESRD. It is also no surprise that your mother-in-law has anemia. A very high percentage of people with ESRD - 80% - have anemia. It is a consequence of chronic kidney disease, which often leads to other serious health problems.

    There are many factors that contribute to CRF anemia. They include iron, folate, and vitamin B12 deficiencies, gastrointestinal blood loss and blood loss from hemodialysis filters and tubes. Co-existing illnesses also play a role. For the most part, this type of anemia is due to a decrease in production of endogenous erythropoietin. A decrease in the lifespan of red blood cells, and the inhibition of erythropoietin by uremic toxins have also been shown to play a role.

    flowergirl

     
    Old 06-15-2009, 12:11 AM   #8
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    Re: Anemia of chronic disease/(chronic) inflammation

    Hi,

    I learned something interesting while researching inflammation that may help explain the difference between anemia of chronic inflammation and anemia of chronic renal failure.

    Inflammation greatly contributes to the anemia of chronic renal failure by restricting the bone marrow's responsiveness to the endogenous hormone erythropoietin and ESA therapy.

    Both anemia of chronic disease (aka chronic inflammation) and anemia of renal failure (aka CKD) result in a decreased production of red blood cells. Both are classified as normochromic and normocytic anemias. Anemia of CRF is thought to result mainly from a combination of erythropoietin deficiency and anemia of chronic disease. It is more severe than other forms of anemia and often leads to cardiovascular complications. This type of anemia also contributes to cerebrovascular diseases, poor muscle strength, fatigue and decreased mobility.

    The main cause of anemia of CRF is an impaired production of erythropoietin hormone in the kidneys. Often, there are other contributing factors, such as an abnormal absorption and use of iron, so typical in anemia of inflammation. The two conditions are very closely linked. I read that it is possible for a person with anemia of CRF to develop anemia of inflammation.

    Anemia of CRF does not respond to iron, folate or vitamin B12 supplementation. It is usually treated with synthetic erythropoietin stimulating agents (ESAs). Interestingly, the target hemoglobin level range in people with chronic kidney disease is only 11-12 g/Dl. Higher hemoglobin values are likely to cause harm.

    Initially, I found the articles about anemia of CRF very confusing. Some sources refer to both types of anemia -CRF and chronic disease- as one and the same. They are not.

    flowergirl

    Last edited by flowergirl2day; 06-15-2009 at 12:22 AM.

     
    Old 06-24-2009, 09:24 PM   #9
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    Re: Anemia of chronic disease/(chronic) inflammation

    FG--I am still confused by this but I am glad that you figured it out . Take care. FLFG
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    Last edited by FLFLOWERGIRL; 06-24-2009 at 09:24 PM.

     
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