Progressive Care Nursing Certification (PCCN) Practice Exam

What is the primary cause of anemia in patients with end-stage renal disease?

1. Blood loss in the urine

2. Renal insensitivity to vitamin A

3. Inadequate production of erythropoietin

4. Inability of the kidney to retain iron

The correct answer is: Inadequate production of erythropoietin

In patients with end-stage renal disease (ESRD), the primary cause of anemia is indeed the inadequate production of erythropoietin. Erythropoietin is a hormone produced by the kidneys that stimulates the bone marrow to produce red blood cells. In ESRD, the damaged kidneys are unable to produce sufficient amounts of erythropoietin, leading to decreased red blood cell production and subsequent anemia. The production of erythropoietin is closely linked to the oxygen levels in the blood; when oxygen levels are low, erythropoietin production increases. However, with kidney dysfunction, this regulatory mechanism fails, contributing significantly to the anemia observed in these patients. Consequently, treating anemia in ESRD often involves supplementation of erythropoietin or its analogs to stimulate red blood cell production. Understanding this mechanism is crucial for treating anemia in ESRD patients, as it emphasizes the importance of addressing erythropoietin deficiency rather than focusing solely on other factors like blood loss or iron retention issues, which may also play roles but are not the primary cause of anemia in this scenario.