Anaemia becomes an increasing problem in CKD as GFR falls. Severe renal anaemia is uncommon before at least stage 3B CKD. Other causes need to be considered, but when not present, Erythropoietin-like drugs (epoetins) and intravenous iron management are the mainstay of management and greatly improved patient symptoms and quality of life.
Investigation and management of anaemia in CKD
- Exclude other causes of anaemia
- When Hb falls far below 10-11g/dl, treatment with intravenous iron ± erythropoiesis stimulating agents may be considered
- Treatment aims to maintain Hb between 11 and 12 g/dl.
- Lower levels of Hb are acceptable if the Hb fails to rise despite adequate iron replacement and epoetin therapy.
There are likely to be local algorithms and protocols for management of renal anaemia. These may include different treatment initiation and target Hb values.
Information for patients
There are several websites dealing with this subject, some from companies that manufacture the treatments, but most give little detail. Epoetins have dramatically improved the symptoms of CKD by making anaemia treatable in most patients. Here are some sources of further info: