Anaemia is common in chronic kidney disease (CKD), encompassing non-dialysis dependent CKD (NDD-CKD) and dialysis dependent CKD (DD-CKD); people on peritoneal dialysis (PD) and haemodialysis (HD); and kidney transplant recipients (KTR). Iron deficiency and erythropoietin deficiency (a consequence of impaired oxygen sensing by the failing kidneys) are perhaps the most common causes of anaemia in people with CKD, especially those requiring kidney replacement therapy (KRT/dialysis). The Renal National Service Framework and National Institute for Health and Clinical Excellence in the UK, and Kidney Disease Improving Global Outcomes (KDIGO), all advocate treatment of anaemia in people with CKD. Blood transfusions are infrequently required, and newer therapies such as Hypoxia-Inducible Factor (HIF-PHI) stabilisers are now in current use. Anaemia is a major clinical problem in people suffering from CKD. This guideline adds to the previous 2017 and updated 2020 anaemia guidelines. Specifically, we aim to:
- Provide guidance on the use of iron in people with NDD-CKD and DD-CKD with added information from several RCTs.
- Comment on iron deficiency without anaemia in people with CKD.
- Provide further information on anaemia management in people with a transplant.
- Provide guidance in the use of the new HIF-PHI drugs in people with NDD-CKD and comment on use in DD-CKD.
- Comment on the potential new therapies to be aware of for future.
- Support safe implementation of therapies.
- Update audit and research recommendations.
We offer evidence based graded practice guidance covering appropriate use of HIF-PHI in people with CKD, accompanied by recommendations for implementation, clinical research and audits.
I am enormously grateful to all the members of the guideline working group for volunteering so generously their time and expertise in revising and further developing this guideline. I would like to particularly thank my NIHR fellow, Dr Sebastian Spencer, for his efforts as an NIHR trainee.
Prof Sunil Bhandari
Chair of Guideline Working Group