Anaemia and chronic kidney disease

Abstract

Anaemia is a common complication of chronic kidney disease. The most important contributory factor is an abnormally low circulating concentration of erythropoietin, which is produced by the kidney peritubular cells. Anaemia of kidney disease is likely to develop once the glomerular filtration rate (GFR) is <60 ml/minute/1.73 m2, and is most evident at lower levels of renal function (estimated GFR <30 ml/minute/1.73 m2). Anaemic patients with a lesser degree of renal function should be screened for other causes. The combination of intravenous iron and recombinant erythropoietin therapy has transformed the management of renal anaemia and drastically reduced the need for repeated blood transfusions, particularly in individuals requiring haemodialysis. The monthly administration of 400 mg iron in haemodialysis patients is associated with fewer cardiovascular events compared with patients given half this dose. Although erythropoietin and iron remain the standard of care, the National Institute for Health and Care Excellence has recently approved the use of roxadustat, which targets the enzyme prolyl hydroxylase.