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Guideline 1.3 – Evaluation of Anaemia – Kidney Function

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)

Rationale

The prevalence of anaemia in people with NDD-CKD increases as the GFR progressively falls (1). NHANES III data demonstrate a prevalence of anaemia of 1%, 9% and 33% in people with NDD-CKD with an eGFR of 60, 30 and 15 ml/min/1.73m2 respectively (2). UK data of > 112,000 unselected patients in the general population showed a population prevalence of NDD-CKD G3-G5 of 4.9% (3). In these people the prevalence of sex specific anaemia (<120 g/L men: < 110 g/L women) was 12%.

Anaemia is more prevalent among people with diabetes. In addition, anaemia of CKD develops earlier in people with diabetes compared with people who do not have diabetes (4-8). In a cross-sectional study involving over 800 people with diabetes, anaemia has been found to be two to three times more prevalent in patients with diabetes compared with the general population at all levels of GFR (9).

References

  1. http://www.renal.org/eGFRcalc/GFR.pl. (Accessed 15/06/2017)
  2. Cheng CK, Chan J, Cembrowski GS, van Assendelft OW. Complete blood count reference interval diagrams derived from NHANES III: stratification by age, sex, and race. Lab Hematol 2004; 10: 42- 53.
  3. de Lusignan S, Chan T, Stevens P et al. Identifying patients with chronic kidney disease from general practice computer records. Fam Pract 2005; 22: 234-241.
  4. Guralnik JM, Eisenstaedt RS, Ferrucci L, et al. Prevalence of anaemia in persons 65 years and older in the United States: Evidence for a high rate of unexplained anaemia. Blood 2004; 104:2263-2268.
  5. Ishimura E, Nishizawa Y, Okuno S et al. Diabetes mellitus increases the severity of anaemia in non-dialyzed patients with renal failure. J Nephrol 1998; 11:83-86.
  6. Bosman DR, Winkler AS, Marsden JT et al. Anaemia with erythropoietin deficiency occurs early in diabetic nephropathy. Diabetes Care 2001;24:495-499.
  7. Thomas MC, MacIsaac RJ, Tsalamandris C et al. Unrecognized anaemia in patients with diabetes: A cross-sectional survey. Diabetes Care 2003; 26:1164-1169.
  8. Thomas MC, MacIsaac RJ, Tsalamandris C et al. The burden of anaemia in type 2 diabetes and the role of nephropathy: A cross-sectional audit. Nephrol Dial Transplant 2004; 19:1792-1797.
  9. El-Achkar TM, Ohmit SE, McCullough PA et al. Higher prevalence of anaemia with diabetes mellitus in moderate kidney insufficiency: The Kidney Early Evaluation Program. Kidney Int 2005; 67:1483-1488.