Anemia in Chronic Kidney Disease

Abstract

Anemia is common in children with chronic kidney disease (CKD), and the prevalence of this comorbidity increases with advancing CKD stage, affecting nearly all children treated with chronic dialysis. The primary causes of anemia in CKD are erythropoietin (EPO) deficiency/dysregulation, and iron deficiency/disorders of iron metabolism. This chapter reviews the pathogenesis of anemia and current approaches to clinical management including the initial diagnostic evaluation and the use of erythropoiesis stimulating agents (ESA) and iron supplementation. Clinical practice guidelines for anemia treatment goals are reviewed. Particular attention is paid to emerging novel anemia therapies made possible by our improved understanding of the molecular regulation of both EPO production and iron metabolism in the setting of CKD; longer-acting ESA, hypoxia inducible factor stabilizers/prolyl hydroxylase inhibitors, and novel approaches to iron supplementation and management of hepcidin-mediated iron restriction. The approach to ESA-resistant anemia is also discussed. Finally, the approach to prevention, evaluation, and management of anemia after successful kidney transplantation is discussed.