Treatment of anemia in nondialysis chronic kidney disease
- Jeffrey S Berns, MD
Jeffrey S Berns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- Professor of Medicine
- Perelman School of Medicine at the University of Pennsylvania
Anemia is common among patients with chronic kidney disease (CKD). Anemia underlies many of the symptoms associated with reduced kidney function and is associated with increased mortality and hospitalizations [1-4].
The screening and treatment of anemia in nondialysis CKD patients are discussed here. Our approach to screening and treating anemia among hemodialysis and peritoneal dialysis patients is discussed elsewhere. (See "Treatment of iron deficiency in hemodialysis patients" and "Treatment of anemia in peritoneal dialysis patients".)
The treatment of iron deficiency among nondialysis CKD patients, hemodialysis patients, and peritoneal dialysis patients is discussed elsewhere. (See "Treatment of iron deficiency in nondialysis chronic kidney disease (CKD) patients" and "Treatment of iron deficiency in hemodialysis patients" and "Treatment of iron deficiency in peritoneal dialysis patients".)
Anemia is defined by the World Health Organization (WHO) as a hemoglobin (Hb) concentration <13.0 g/dL for adult males and postmenopausal women and an Hb <12.0 g/dL for premenopausal women . (See "Approach to the adult patient with anemia", section on 'Normal ranges for hemoglobin/HCT'.)
However, the WHO definition of anemia does not define goals of treatment among CKD patients. Thus, even when adequately treated, many CKD patients will have anemia as defined above. This is because the treatment of anemia involves erythropoiesis-stimulating agents (ESAs); multiple studies have now shown that targeting a normal Hb with ESAs increases risks of adverse outcomes. (See 'Target hemoglobin value' below.)
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- Jing Z, Wei-jie Y, Nan Z, et al. Hemoglobin targets for chronic kidney disease patients with anemia: a systematic review and meta-analysis. PLoS One 2012; 7:e43655.
- Pfeffer MA, Burdmann EA, Chen CY, et al. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009; 361:2019.
- Initial screening
- Continued monitoring
- - Patients without anemia
- - Patients with anemia but not on an ESA
- - Patients treated with an ESA
- - Patients treated with iron
- Erythropoiesis-stimulating agents
- - Indications and contraindications
- - Route of administration
- - Dosing
- - Target hemoglobin value
- - Adverse effects
- SUMMARY AND RECOMMENDATIONS