• Reference Number: HEY-792/2020
• Departments: Renal Service
• Last Updated: 2 January 2020

Introduction

This leaflet has been produced to give you general information about your condition.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is renal anaemia?

Renal anaemia (low red blood cell count) is a complication of your kidney disease. Healthy kidneys produce a hormone called Erythropoietin (EPO) to stimulate the production of red blood cells. These red blood cells contain haemoglobin, which is needed to carry the oxygen from your lungs around your body. When your kidneys are not working properly, not enough EPO is produced and your body is unable to make the new red blood cells needed.

Symptoms of anaemia may include:

• Pale complexion.
• Shortness of breath.
• Feeling cold.
• Persistent tiredness.
• Poor concentration.
• Poor appetite.
• Low sex drive.

Who do I need iron and/or EPO?

As the anaemia develops over a period of time it is called chronic anaemia. This type of anaemia is damaging to the heart muscle because it results in the heart having to pump harder and faster to get oxygen around the body. If it goes untreated for a long period of time this can result in the heart muscle becoming thick and stiff and ending up unable to pump effectively.

This can be prevented by treating the anaemia with iron (tablet form or through a drip) and if needed EPO therapy. Treatment for your anaemia is therefore an important part of your treatment plan.

Oral Iron – You may be taking iron in tablet form, but it is often poorly absorbed and can sometimes result in stomach upsets. If you are taking oral iron we need you to stop taking it before you come in for iron treatment through a drip (iron infusion).

What will happen?

Iron therapy

We will try to provide your infusion of iron as near to home as possible but it may require a visit to the Hull Royal Infirmary Medical Day Unit. It is important that you tell us if you have any allergies or if you are asthmatic before we give you any iron therapy.

Possible side effects of iron:

• Nausea.
• Dizziness.
• Headache.
• Rash.
• Metallic taste.

Serious reactions requiring medical attention are very rare. They occur very infrequently.

EPO therapy

To correct your anaemia we may prescribe a manufactured EPO as an injection just under the skin, to do the work your kidneys no longer can do. EPO therapy is usually given monthly until your anaemia has been corrected but occasionally the dose or frequency may change depending on your blood results.

You will be encouraged to learn to administer it yourself, or we may be able to show someone nominated by yourself, to give you the injection. In some instances the nurse at your doctor’s surgery or the district nurse may give the injection for you.

It is important that your blood pressure is monitored closely because as the EPO works and your haemoglobin rises, so can your blood pressure. Again this can be monitored by your practice nurse or district nurse.

For EPO to work effectively your body needs adequate iron stores and you may from time to time be asked to come in for an iron infusion, which is given via a drip, to ensure you have enough iron to help support the formation of good quality red blood cells. Not all patients need to have EPO and sometimes giving iron is enough to correct your anaemia. You will be told if this applies to you.

The body requires adequate stores of vitamins, folic acid and B12 which are necessary to help make the red blood cells. As part of your assessment we will measure these levels and you may need to take supplements. If this applies to you we will inform you of the treatment required.

What happens afterwards?

A nurse practitioner who specialises in anaemia management will coordinate your care. The nurse will be available for support and queries for patients, carers, health professionals and hospital staff on all aspects of your anaemia management.

The nurse will provide you with the information required to ensure safe and efficient treatment for your anaemia and arrange the supply of EPO from our Home Delivery Service.

You may be asked to ring regularly with blood pressure readings that your doctor has taken and to inform us that you have had your blood tests done.

Should you require further advice please contact the renal nurse practitioner (01482) 608754, Monday to Friday, 7.00am to 3.00pm. Weekends – messages can be left on the answerphone and will be checked on the next working day.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.