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Connection Between Anemia, Kidney Disease, and Your Heart

Feb 13, 2023

In the U.S., more than 1 in 7 (15%) of adults are estimated to have chronic kidney disease, with as many as 9 in 10 adults not knowing that they have CKD. Two of the most common causes of CKD are hypertension and diabetes, with other risk factors including heart disease.

The term “heart disease” encompasses several types of heart conditions, with the most prevalent condition in the U.S. being coronary artery disease (CAD). Heart disease affects the blood flow to the heart.

These two diseases may appear to affect two different organs separately. Coupled with anemia, this triad of diseases is connected and presents a further clinical challenge to the U.S. healthcare system.

Key Points

  • The kidneys and the heart share a codependent relationship.
  • In patients with CKD, heart disease is often underdiagnosed and undertreated.
  • Chronic Kidney Disease (CKD) and Anemia are associated with poor outcomes in heart failure patients.
  • The trio connection of heart failure, anemia, and kidney disease is well-detailed and is frequently seen in clinical practice.

The Heart and Kidney Connection

The kidneys not only play an essential role in filtering the blood and removing waste products and excess fluid as urine, but they also regulate electrolytes. Electrolytes are necessary for the proper function of nerve cells and muscles in the body. They also play a role in balancing fluid and sodium levels and producing hormones that control blood pressure.

The heart is a muscle that primarily functions as a pump that moves blood around the body as the heart beats. This blood transports oxygen and nutrients to all parts of the body and carries away waste products and carbon dioxide.

The connection between the heart and the kidneys is a codependent relationship. The heart pumps oxygenated blood throughout the body, and the kidneys filter the blood, removing waste and excess fluid. This connection may also result in a negative codependent relationship between the two organs.

For example, kidney function may become compromised if you have a compromised heart that cannot produce enough blood flow. On the other hand, without the kidneys functioning properly, the heart may be under stress and unable to function correctly.

The connection between kidney disease and heart disease 

Research shows CKD patients are more likely to develop cardiovascular (heart) disease, while cardiovascular disease in patients with CKD currently may only be explained by the presence of traditional risk factors. Kidney disease and cardiovascular disease share the same main risk factors; hypertension (high blood pressure), smoking, obesity, dyslipidemia, and diabetes.

In dialysis patients, heart disease is the most common cause of loss of life, and CKD may be considered a strong risk factor for the development of heart disease.

Can kidney failure cause a heart attack? 

The term “heart disease” may include heart attack, coronary artery disease (CAD), problems with the muscle, valves, or heartbeat, or a blood clot that blocks the flow of blood to the heart.

When the kidneys are no longer functioning correctly, as observed in end-stage renal disease (ESRD) or kidney failure, this increases the amount of stress placed on the heart. This is because the heart needs to pump harder to get blood to the kidneys. Hypertension (high blood pressure), a complication of CKD, may also lead to heart disease.

Does Anemia Cause Kidney Problems? 

Anemia is a condition that negatively affects the number of red blood cells or hemoglobin present in your blood. Hemoglobin is the iron that allows red blood cells to carry and transport oxygen from the lungs to the rest of the body. When fewer red blood cells or less hemoglobin are present, organs and tissues, such as the heart and kidneys, may not get enough oxygen to work correctly.

Anemia is a common complication of CKD, especially in those with more advanced stages, and often worsens as the kidney disease progresses. More than 1 in 7 people with CKD are estimated to have anemia. The risk of developing anemia in CKD patients increases the further the disease progresses.

What causes anemia in CKD? 

Anemia in CKD cases is often due to more than one cause. When the kidneys are damaged they produce less erythropoietin (EPO), which is responsible for signaling the bone marrow to produce red blood cells. When there is less EPO produced, the body makes fewer red blood cells, resulting in less oxygen being delivered to the body’s tissues and organs.

The red blood cells in people with anemia and CKD tend to have a shorter lifespan in the bloodstream. So, in addition to there being fewer red blood cells, the blood cells die faster than the body can normally replace them.

If their diets are deficient, people with CKD and anemia may have low levels of vital nutrients needed to make red blood cells, such as vitamin B12, iron, and folate.

Causes of anemia related to CKD include:

  • Inflammation
  • Infection
  • Blood loss, especially if you are treated with dialysis for kidney failure
  • Malnutrition

The Relationship Between Anemia, Kidney Disease, and The Heart 

When you have kidney disease, your kidneys can no longer function properly, and you may develop anemia. Recent studies suggest that anemia is also a risk factor for heart failure. In CKD patients, severe anemia may increase the chance of heart disease, as the heart is getting insufficient amounts of oxygen and is working harder than normal to pump enough red blood cells to tissues and organs.

Another example of the relationship between this trio is that the kidneys produce EPO, a hormone that regulates blood pressure and stimulates the production of red blood cells, both of which may negatively affect the heart.

Studies suggest that the majority of people with CKD have unfavorable outcomes due to cardiovascular disease, rather than ESRD or dialysis. The increased burden of heart disease in CKD populations, and vice versa, is a reflection of shared similar risk factors. The absence or presence of anemia further complicates the relationship between CKD and heart disease.

Anemia is also common in heart failure patients and is associated with increased hospitalizations and decreased survival rates. The most effective way to prevent cardiovascular disease is to treat or prevent the problems that may cause it, such as anemia, hypertension, and diabetes.

Panoramic Health 

Panoramic Health is a physician-led organization with 14 years of experience managing outcomes using predictive analytics, the largest live CKD database, and care management tools. We are uniquely positioned and qualified to care for our patients holistically. Our integrated value-based care platform provides patients with comprehensive care management to keep them healthy longer-at home and out of the hospital.

Our holistic care management includes services and frequency of these services customized to the patient’s disease stage and risk profile, helping slow disease progression and increasing quality of life.