From the Guidelines
Anemia in patients with Chronic Kidney Disease (CKD) not on dialysis is primarily caused by a combination of iron deficiency, decreased erythropoietin production, and other multifactorial mechanisms, including haemolysis and plasma cell dyscrasias, as stated in the British Society of Gastroenterology guidelines 1. The causes of anemia in CKD are complex and multifaceted. Key factors include:
- Iron deficiency, which is a major contributor to anemia in CKD patients, and can be due to reduced iron intake, impaired iron absorption, and blood loss via various routes 1
- Decreased erythropoietin production by the kidneys, which typically occurs when estimated glomerular filtration rate falls below 60 ml/min/1.73m²
- Haemolysis and plasma cell dyscrasias, which can also contribute to the development of anemia in CKD patients 1
- Other potential causes, such as chronic inflammation, uremic toxins, and nutritional deficiencies, which can further exacerbate anemia Assessment of iron deficiency in CKD can be challenging, and requires careful interpretation of ferritin and transferrin saturation levels, as well as consideration of the patient's overall clinical context 1. The management of anemia in CKD patients not on dialysis typically involves a comprehensive approach, including iron supplementation, erythropoiesis-stimulating agents, and regular monitoring of hemoglobin levels, with the goal of maintaining optimal hemoglobin levels and minimizing complications 1.