Hi, Anemia is very common in those with chronic kidney disease and is caused by multiple reasons. People with chronic kidney disease do not create a signal in the body to create more red blood cells (erythropoietin). The red blood cells also tend to die sooner than if someone had perfectly functioning kidneys. This makes replacing them even more important. Red blood cells can also be lost due to bleeding issues. Lastly, nutritional problems can lead to difficulties in the body creating red blood cells and hemoglobin (an important part of red blood cells). Your friend s kidney doctor should be monitoring his red blood cells and can start EPO treatment if needed. Making sure that he is on a good kidney diet that is full of nutrients can also help. Also, making sure that he isn t bleeding anywhere (checking his bowel movements for blood) can help prevent blood loss. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Timothy Wong, General & Family Physician