The prevalence of anaemia at higher levels of glomerular filtration rate (GFR) (i.e. CKD stage 1-2) is relatively low in individuals from the general population.
Anaemia of CKD is primarily caused by deficiency of erythropoietin.
The kidneys are the major source of erythropoietin and, as renal function declines, production of erythropoietin declines proportionately.
Though erythropoietin deficiency is common among patients with anaemia in CKD, other potential causes and contributing disorders should be identified or excluded if initial evaluation yields evidence for disorders other than iron deficiency or erythropoietin deficiency.
Correction of anaemia in CKD patients improves survival and quality of life.
Causes of Anaemia in Chronic Kidney Disease
The following are the causes of anaemia in CKD:
- Deficiency of erythropoietin
- Red cell destruction from microvascular disease from diabetes or hypertension
- Increased gastrointestinal bleeding
- Increased oxidative stress leading to shortened red cell survival
Symptoms of Anaemia in Chronic Kidney Disease
(See ‘Anaemia’ for the symptoms)
Signs of Anaemia in Chronic Kidney Disease
(See ‘Anaemia’ for the signs
- Reticulocyte count
- Transferrin saturation
- Serum ferritin
- Stool occult blood
Treatment for Anaemia in Chronic Kidney Disease
Treatment objectives of anemia in CKD include the following:
- To achieve and maintain a target-range Hb level of 11-12 g/dL
- To improve the quality of life of the patients
A. CKD Stages 1-2
1st Line Treatment
Evidence Rating: [A]
Ferrous sulphate, oral,
- 325 mg 8 hourly for 4 weeks
B. CKD Stages 3-4
- Target Hb should be 11-12 g/dL
Ferrous sulphate, oral, 325 mg 8 hourly
Ferrous gluconate, oral, 300 mg 8-12 hourly. Evaluate after 4-6 weeks
Iron sucrose, IV, consult specialist
Ferric sodium gluconate complex, consult specialist
Epoietin beta, SC, consult specialist
Methoxy polyethylene glycol epoietin beta (pegylated form of Epo), SC, consult specialist
Darbepoietin alfa, SC, consult specialist
Refer all (adults and children) patients with CKD and anaemia to a specialist or nephrologist.