Flowchart for the evaluation of anemia in patients with chronic kidney disease. TIBC total iron-binding capacity; TSAT transferrin saturation; SF serum ferritin; ESA erythropoiesis-stimulating agent
KDIGO defines anemia in patients with CKD as hemoglobin <130 g/L in adult males and <120 g/L in adult females, <110 g/L in children 0.5–5 years, <115 g/L in children 5–12 years, and <120 g/L in children 12–15 years.
Anemia is a frequent complication in patients with CKD, and its prevalence increases as renal function declines. Hemoglobin levels should be regularly monitored in patients with CKD.
The etiology of anemia in CKD is multifactorial; it includes absolute or relative lack of EPO, iron deficiency, blood loss, shortened red blood cell survival, and other factors.
Anemia in CKD is associated with impaired quality of life, as well as elevated morbidity and mortality of cardiovascular diseases.
ESAs and iron supplementation are the primary treatment for anemia in CKD. Hemoglobin levels and iron status should be monitored regularly during treatment. It is generally recommended that hemoglobin concentration not exceed 115 g/L in patients undergoing ESA maintenance; the monthly hemoglobin growth rate should be ≥10 g/L, but <20 g/L. Transfusions should be avoided as much as possible. HIF prolyl hydroxylase inhibitors is a kind of new promising therapeutic drugs.