What happens

The kidneys control the production of red blood cells, one type of cell in the blood. Red blood cells have a substance called haemoglobin, which carries oxygen around the body. In later stages of CKD, the amount of red blood cells and haemoglobin often drops – this causes anaemia.

Symptoms and signs

The symptoms and signs depend on how severe the anaemia is. They may include:

  • feeling weak and tired
  • looking paler than usual.

More rare symptoms include:

  • feeling breathless
  • feeling dizzy or fainting
  • having a headache.



Most children will need to take iron supplements because they do not have enough iron in their body and are unable to get enough iron from food. Iron helps the body to make more haemoglobin.

Some children (especially children on haemodialysis) may be given iron intravenously (into a vein) during the dialysis session.


Some children benefit from taking folic acid supplements. Folic acid helps the body make more healthy red blood cells.

More about folic acid on the Medicines for Children website

Erythropoietin (EPO) injections

The kidneys make some of our body’s hormones, chemicals that are carried in the blood to send messages to other parts of the body. When the body does not have enough red blood cells, the kidney releases a hormone called erythropoietin. This hormone causes the bone marrow to produce more red blood cells.

As the kidney function gets worse, the kidneys are less able to make this hormone, which causes a drop in healthy red blood cells.

Erythropoietin – which is often shortened to EPO – can be given as a medicine, to help the symptoms of anaemia. It needs to be injected with a needle under the skin – usually one or two times per week. A special gel or cream can be used to help your child stop feeling any pain. You may be able to give these injections at home, using pre-filled syringes or pens – you will be shown how to use these. Children on haemodialysis may be able to get the EPO injections during the dialysis session.

Blood transfusion

This is a procedure to receive healthy blood from a blood donor. It may be needed for children with more serious anaemia. A transfusion usually takes a few hours, and blood is given through a plastic tube in the vein. A special gel or cream can be used to help your child stop feeling any pain.