Why is the patients hemoglobin decreased?

Scenario
S.A. is a 46-year-old female who has chronic kidney disease (CKD) resulting from type I diabetes and hypertension. Last year, she was diagnosed with Stage Three CKD. She has been working with her health care provider to manage diabetes and hypertension, which are underlying causes of her CKD. Unfortunately, she has reported that her efforts to lose weight, reduce her sugar intake, and exercise have been unsuccessful, due to her job as a financial advisor, and the long work hours that leave her no time to prepare healthy foods or make it to the gym.

Today she complains of bone pain in her legs and arms, a reduction in urine output, and darker urine when she can produce. She tells you that she has been feeling weak and tired, but that her work schedule has not changed.

Assessment Details
Vital Signs
Temperature: 98.1F

Pulse: 93 bpm

Blood Pressure: 169/102

Respiratory Rate/Rhythm/Depth: 26/rapid/shallow

O2 Sat: 90

Pain: Rated 8/10 in her legs

Labs
Na-133

K+6.8

Bun-190

Creatinine-20

Calcium-7.2

Phosphorus-11

Hemoglobin-8.2

Hematocrit-28

You notice a foul breath when she speaks, but she tells you that all she has eaten today is oatmeal. She has 2+ peripheral edema in her feet and ankles. While you are checking for edema, you notice that she is scratching her skin continuously. You ask her if her skin is itchy and she tells you that she has been itchy for several weeks.

Directions
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