Snapshot A 60-year-old woman with a history of chronic kidney disease on dialysis and diabetic nephropathy presents for a routine visit. Routine labs reveal a marked anemia to hemoglobin of 8 g/dL. She feels generally very weak and easily fatigable. She is started on EPO with a goal of hemoglobin of 11 g/dL. Introduction Anemia of renal failure, or anemia of chronic kidney disease is a normochromic, normocytic anemia epidemiology Risk factors login to view 3 more bullets etiology Pathogenesis login to view 8 more bullets Presentation Symptoms of anemia, which typically occur if hemoglobin < 10 g/dL login to view 4 more bullets studies Anemia login to view 2 more bullets ↓ Reticulocyte count ↓ Serum EPO May see normal or decreased iron levels Signs of kidney damage login to view 3 more bullets Differential Diagnosis Anemia of chronic disease Iron deficiency anemia Treatment Medical management login to view 9 more bullets Complications Untreated anemia increases risk for cardiovascular events and progression of CKD For patients with CKD, maintaining hemoglobin of > 12 g/dL will increase risk of stroke, diabetes, and cardiovascular events