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Part of it is that kidneys produce erythropoetin, which is a hormone that stimulates red blood cell production in normal people. In kidney disease, this process is diminished.

Also, it is thought that people with some chronic diseases develop what is called "anemia of chronic disease" and it's not clear how this is played out, but it leads to chronic anemia .

Also, people with kidney disease are often fluid over-loaded, and may have a dilutional effect, where the hematocrit and hemoglobin concentration seems lower than it actually is due to so much fluid in the system.

So it's likely due to a combination of the above reasons.

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Q: Why do people with advanced kidney disease commonly become anemic or have reduced RBCs count or levels of hemoglobin?
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