We recommend that all correctable causes of anaemia should be ruled out before considering treatment with ESAs. (1B)
Rationale
Investigations for iron deficiency, folate and B12 deficiency, hyperparathyroidism, inflammatory states as well as gastro-intestinal blood losses should be investigated and addressed before initiating ESA therapy. By addressing any underlying causes and correcting any deficiencies, ESA use may be avoided. (1) Correcting any deficiencies, including iron deficiency, before starting ESA treatment will allow for optimal ESA responses, minimising the dose required to maintain target haemoglobin levels. (2)
References
1. National Collaborating Centre for Chronic Conditions, Royal College of Physicians. Chronic kidney disease: assessment and management. 2021. National Institute for Clinical Excellence. 2. Roger SD, Tio M, Park HC, et al. Intravenous iron and erythropoiesis-stimulating agents in haemodialysis: A systematic review and meta-analysis. Nephrology (Carlton). 2017;22 (12):969- 976.