Som, a Cambodian national, had been suffering from chronic kidney disease, hypertension, type 2 diabetes, and anemia for two years. Despite visiting many clinics and adhering to treatment, she experienced persistent fatigue and weakness. She then traveled to Vietnam to seek examination at Tam Anh General Clinic District 7.

Tests revealed her estimated glomerular filtration rate (eGFR) was only 22,29 mL/min/1,73 m² (typically above 75 mL/min/1,73 m² for her age), indicating stage 4 chronic kidney disease. Her kidney's filtering function was significantly impaired; progression to stage 5 would require renal replacement therapy. The patient's hemoglobin level was below 9 g/dL (normal range 12-16 g/dL), confirming anemia.

Doctor of two specialties Ta Phuong Dung, Deputy Director of the Urology - Nephrology - Andrology Center and Head of the Internal Medicine - Dialysis Department at Tam Anh General Hospital TP HCM, explained that Som's long-standing hypertension had damaged small blood vessels in her kidneys. Meanwhile, prolonged high blood sugar could harm the glomeruli, reducing the kidneys' filtering and regulatory capacity. These conditions can interact, causing kidney disease to progress rapidly if not well-controlled.

When kidney function declines, the kidneys not only filter waste less effectively but also reduce the production of erythropoietin, a hormone that stimulates the bone marrow to produce red blood cells. This leads to anemia, which decreases oxygen transport to tissues. Patients often experience fatigue, weakness, reduced mobility, and a lack of energy, even after long-term treatment for underlying conditions.

Doctor Dung prescribed a treatment regimen for Som, adjusting medication according to her kidney function while controlling blood pressure, blood sugar, and treating anemia with red blood cell-stimulating drugs. Initially, she took medication three times each week. Doctors regularly checked her complete blood count and kidney function to adjust the dosage and frequency based on her response. Her nutritional plan was individualized to her condition, lifestyle habits, and familiar diet, making it easier for her to follow and sustain long-term.

Som during a follow-up appointment with Doctor Dung in early September. Photo: Tam Anh General Clinic District 7

After 6 months of treatment, her kidney function and anemia significantly improved. Her eGFR increased to 45,57 mL/min/1,73 m²—more than double her initial reading—corresponding to stage 3a chronic kidney disease. Hemoglobin rose to 12,5 g/dL. The frequency of red blood cell-stimulating medication was reduced from three times each week to once each month. She no longer experienced chronic fatigue, and her health stabilized.

The interval between Som's follow-up appointments decreased from once every two weeks to once each month, then once every two months. Doctors continue to monitor her kidney function, anemia, and underlying conditions to maintain results and make timely adjustments as needed. "I didn't think that at 79, I would be healthy enough to travel and sightsee with my family after coming to Vietnam for follow-up appointments," Som said.

According to Doctor Dung, chronic kidney disease often progresses silently, with symptoms only appearing when kidney function has significantly declined. Kidneys' reduced ability to filter waste and produce erythropoietin leads to anemia. Iron deficiency or other chronic diseases can also contribute to anemia.

Patients with chronic kidney disease should regularly monitor kidney function, blood pressure, blood sugar, and anemia. Doctors will develop a treatment plan tailored to the degree of kidney function decline, the cause of anemia, and co-existing conditions.

Doctor Dung recommends that individuals with diabetes, hypertension, overweight or obesity, or other risk factors for kidney disease should undergo regular kidney function checks, avoid self-medicating, adhere to dietary guidelines, and control blood pressure and blood sugar. Scheduled follow-ups help detect changes in kidney function early and allow for timely treatment adjustments.

Dinh Lam

*Patient's name has been changed