Guideline 1.1
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)
Rationale
There is insufficient literature to suggest the ideal frequency of Hb testing in people with CKD who are not on ESA therapy. Alternatively, data from clinical trials have shown that the rate of Hb decline in these people is gradual (1, 2). In a Canadian study to assess the effect of ESA therapy on left ventricular mass in people with CKD (2) 172 people were assigned either to receive therapy with erythropoietin α subcutaneously to maintain or achieve Hb level targets of 120 to 140 g/L, or to the control/delayed treatment group with mean Hb levels of 90 ± 5 g/L. During 2 years’ follow up a significant proportion of patients eventually required ESA therapy. However, among those who did not require ESA therapy, mean Hb values remained relatively stable throughout the study period. Hb level should be measured at least monthly in CKD G5 haemodialysis patients and every three months in CKD G5 peritoneal dialysis patients.
KDIGO 2012 guidelines suggest measurement of Hb at least annually in patients with NDD-CKD G3, at least twice per year in patients with NDD-CKD G4–5 and at least every 3 months in patients with CKD G5HD and CKD G5 PD. For those treated with an ESA, they recommend measuring Hb concentration when clinically indicated and at least every 3 months in patients with NDD-CKD G3–5 and CKD G5 PD and at least monthly in patients with CKD G5 HD (3).
References
- Roger SD, McMahon LP, Clarkson A, et al. Effects of early and late intervention with epoetin α on left ventricular mass among patients with chronic kidney disease (stage 3 or 4): Results of a randomized clinical trial. J Am Soc Nephrol 2004; 15:148-156.
- Levin A, Djurdjev O, Thompson C, et al. Canadian randomized trial of haemoglobin maintenance to prevent or delay left ventricular mass growth in patients with CKD. Am J Kidney Dis 2005; 46:799-811.
- KDIGO Clinical Practice Guideline for Anaemia in Chronic Kidney Disease. Kidney Int Suppl 2012;2:279-33