Guideline 1.1 – Evaluation of Chronic Anaemia – Screening for Anaemia:
We suggest that haemoglobin (Hb) levels should be routinely measured to screen for anaemia:
- At least annually in people with CKD G3
- At least twice a year in people with CKD G4-5 not on kidney replacement therapy (2B)
Guideline 1.2 – Evaluation of Anaemia – Haemoglobin Level:
We recommend that all people with anaemia associated with chronic kidney disease should be investigated for the cause and possible treatment, irrespective of the grade of kidney disease or requirement for kidney replacement therapy if:
- Their haemoglobin (Hb) levels are less than 110 g/L (less than 105 g/L if younger than 2 years), or they develop symptoms attributable to anaemia. This is to ensure the correct diagnosis and management of anaemia. (1A)
Guideline 1.3 – Evaluation of Anaemia – Kidney Function:
We suggest that CKD should be considered as a possible cause of anaemia when the glomerular filtration rate (GFR) is < 60 ml/min/1.73m2. It is more likely to be the cause if the GFR is <30ml/min/1.73m2 (< 45 ml/min/ 1.73m2 in people with diabetes) and no other cause, e.g., blood loss, folic acid or vitamin B12 deficiency, is identified. (2B)
Guideline 1.4 – Evaluation of Anaemia – Erythropoietin Measurement:
We recommend that measurement of erythropoietin levels should NOT routinely be considered for the diagnosis or management of anaemia for people with CKD. (1A)
Guideline 1.5 – Evaluation of Anaemia – Baseline Investigations:
We recommend that initial clinical and laboratory evaluation of anaemia should be performed prior to initiation of treatment for anaemia in people with CKD. (1A)
Guideline 1.5.1
We recommend that laboratory evaluation should include the following tests (1B):
- Full blood count (FBC) in addition to the Hb concentration
- Red blood cell indices:
- Mean corpuscular haemoglobin [MCH]
- Mean corpuscular volume [MCV]
- Mean corpuscular haemoglobin concentration [MCHC])
- White blood cell count and differential count
- Platelet count
- Absolute reticulocyte count to assess bone marrow responsiveness (if indicated)
Tests to Determine Iron Status:
- Percentage of hypochromic red blood cells (% HRC), but only if processing of blood sample is possible within 6 hours or
- Reticulocyte Hb count (CHr) or equivalent tests e.g., reticulocyte Hb equivalent (RET-He) or
- Combination of transferrin saturation (TSAT) and serum ferritin if the above tests are not available or the person has thalassemia or thalassemia trait
- Serum ferritin to assess iron stores
- Plasma/serum C-reactive protein (CRP) to assess possible inflammation
Guidelines 1.5.2
Based on initial assessment, we recommend the following tests to diagnose the cause of anaemia in selected cases (1B):
- Serum B12 and serum folate concentrations
- Tests for haemolysis (plasma/serum levels of haptoglobin, lactate dehydrogenase, bilirubin, Coombs’ test)
- Plasma/serum and/or urine protein electrophoresis
- Hb electrophoresis
- Free light chains and bone marrow examination