The anemia of chronic kidney disease (CKD) is, in most patients, normocytic and normochromic. It is principally due to reduced renal erythropoietin production and, to a lesser degree, to shortened red cell survival and decreased responsiveness to the hormone.
Anemia can develop well before the onset of uremic symptoms due to end-stage renal disease (ESRD). Although anemia due to renal dysfunction generally develops when the glomerular filtration rate (GFR) declines to <30 mL/min, it can also be observed in those with markedly higher GFRs (such as 60 mL/min) and tends to occur at higher levels of GFR in African Americans than whites.
If left untreated, the anemia of CKD is associated with several abnormalities. These include deterioration in cardiac function, decreased cognition and mental acuity, fatigue, and other signs and symptoms. There are also associations with an increased risk of morbidity and mortality, principally due to cardiac disease and stroke.
The primary therapeutic options for the anemia of CKD include red blood cell transfusions, erythropoiesis-stimulating agents (ESAs), and, to a much lesser degree, androgens.
The use of erythropoietin in the treatment of anemia of CKD in predialysis patients with CKD is discussed in this topic review. A discussion of its use in hemodialysis and peritoneal dialysis patient is presented separately. (See "Erythropoietin for the anemia of chronic kidney disease in hemodialysis patients" and "Erythropoietin: Subcutaneous administration", section on 'Peritoneal dialysis patients'.)