Interactive Guidelines
Anaemia is common in 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.
This guideline has been developed with a focus on BP management, acknowledging the central role of body fluid status in adults and CYP receiving dialysis (6, 7). Existing guidance does not focus on the systematic evaluation of the evidence base for BP management in dialysis-dependent adults and CYP and, as such, highlights the need for specific guidelines (1, 6).
Haemodialysis continues to expand in the UK, with over 25,000 patients now being treated, representing a 10% increase since the publication of the previous Renal Association guideline for haemodialysis. In addition, the patient group continues to develop: the typical patient is now 67 years old with a median history of 3.2 years on renal replacement therapy.
An update of the UKKA Hyperkalaemia Guideline (2020) was prompted following enquiries related to the administration of Calcium Gluconate and to provide new guidance related to the use of oral potassium binders and blood glucose monitoring. Therefore, the main changes to treatment recommendations are within the Hospital Section of this update.
Since the publication of the first UKKA clinical practice guideline for the use of SGLT 2 inhibition in adults with kidney disease in October 2021, two large and highly relevant clinical trials have been published (DELIVER and EMPA KIDNEY). In light of this new evidence, the 2021 guidelines have been reviewed and updated by the original working group members. The structure of the 2021 guideline which provided recommendations for use for people with diabetes (section 2) and without diabetes (section 3) separately has been retained.