Chronic kidney disease and its complications:

ANAEMIA

Anaemia of chronic kidney disease is related to:

• Reduced erythropoetin production by the kidney
• resistance to the action of erythropoiesis stimulating agent
• Reduced absorption of iron

Anaemia related to chronic kidney disease usually starts to develop when the GFR is less than 60 ml/min/1.73m2. The prevalence of anaemia increases markedly with decreasing GFR

Management:

Other forms of anaemia should be considered and excluded

• B12 and folate levels should be checked and corrected if deficient
• Iron deficiency is a common cause of anaemia in people with chronic kidney disease
• If iron deficiency is identified, other cause should be excluded (e.g. blood loss)
• Prior to commencement of erythropoiesis stimulating agent  a trial of IV iron should be considered to maintain ferritin > 100µg/L