Practice Guidelines

Management of anaemia in chronic kidney disease: summary of updated NICE guidance

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2258 (Published 04 June 2015) Cite this as: BMJ 2015;350:h2258
  1. Smita Padhi, senior research fellow1,
  2. Jessica Glen, senior research fellow1,
  3. Ben A J Pordes, project manager1,
  4. Mark E Thomas, consultant physician and nephrologist 2
  5. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK
  1. Correspondence to: M E Thomas mark.thomas{at}heartofengland.nhs.uk

The bottom line

  • Various factors—including deficiency of erythropoietin, iron, folate, or vitamin B12; blood loss; infection; and inflammation—contribute to the development of the anaemia of chronic kidney disease

  • Recognise anaemia by monitoring the blood count as well as glomerular filtration rate

  • Consider investigating and managing anaemia when haemoglobin falls to 110 g/L in adults or 105 g/L in children under 2 years

  • To diagnose iron deficiency, use percentage hypochromic red cells (>6%; only if processing within six hours is possible), reticulocyte haemoglobin content (<29 pg), or reticulocyte haemoglobin equivalent

  • Do not use ferritin or transferrin saturation alone to monitor for iron deficiency

How patients were involved in the creation of this article

Lay members of the Guideline Development Group involved in this guideline update contributed to the formulation of the recommendations summarised here. Patient organisations were among the registered stakeholders who were consulted at both scoping and development stages.

About 5% of the population of the United States and United Kingdom have stages 3-5 chronic kidney disease (CKD; estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2),1 2 and about 15% of these people have anaemia according to World Health Organization criteria.2 Overall more than 100 000 people in the UK have anaemia of CKD.3 Anaemia of CKD develops as renal disease progresses, and it is mainly caused by erythropoietin deficiency; other contributory factors include deficiency of iron, folate, or vitamin B12; blood loss; and infection or inflammation. This article summarises 2006 and 2011 guidance from the National Institute for Health and Care Excellence (NICE) on the management of anaemia of CKD,3 4 and it also highlights key points of the 2015 update.5

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience …

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