Managing the anaemia of chronic kidney disease

Abstract

Summary Anaemia is a common manifestation of chronic kidney disease, especially when the glomerular filtration rate falls below 30 m l/min. It is important to exclude other causes of anaemia such as iron and other haematinic deficiencies, chronic inflammation, malignancy and drugs. After reversible causes of anaemia are excluded, supplementary erythropoietin (epoetin) can be considered when the patient's haemoglobin concentration falls below 100 g/ l. Patients treated with epoetin often require supplements of oral or intravenous iron to maintain adequate iron stores during the correction and the maintenance phases of management. The main adverse effect of epoetin use is the development or worsening of hypertension. Care must also be taken not to overshoot the target haemoglobin of 110–120 g/ l, as this can be associated with a prothrombotic tendency.