Functioning kidneys produce a hormone called erythropoietin (EPO), which stimulates the production of red blood cells. Kidney failure reduces EPO production and red blood cell levels. This decrease can cause anemia, a condition that lowers the oxygen in the bloodstream and leaves people feeling unusually weak and fatigued. They may also find it difficult to breathe after exerting themselves. About 12% of people with CKD develop anemia.

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