Chronic Kidney Disease

Anaemia

Patients with chronic kidney disease are at risk of developing anaemia. The NICE guidelines on the management of renal anaemia provide comprehensive advice and can be found here.

For adults, renal anaemia should be considered, and treatment offered if the haemoglobin concentration is < 11 g/dL. At present in Southern Derbyshire the full guidance has not been implemented, but referral to nephrology for potential renal anaemia should be considered. It is important to exclude other causes of anaemia, especially iron, B12 and folic acid deficiency.

Treatment for renal anaemia includes the use of intravenous iron and erythropoiesis-stimulating agents (ESAs). Oral iron supplements are ineffective, and interfere with many other medications, such as phosphate binders.

A target haemoglobin of between 10.5 and 12.5 g/dL and a ferritin between 200 and 500 ug/Lis the aspiration, although in some patients this will be difficult to achieve. In general, doses of ESA will therefore need adjustment when the haemoglobin is less than 11 or more than 12 g/dL.

At present patients receiving renal replacement therapy from the Derby City General Hospital renal unit will have the necessary medication provided from the renal unit.