Anaemia in chronic kidney disease

Anaemia, occurring in over 50% of patients with stages 3 to 5 chronic kidney disease (CKD), often causes fatigue, shortness of breath, cardiac dysfunction and cognitive impairment. The major causes include disorders of iron metabolism (both iron deficiency and iron blockade) and erythropoietin deficiency. Treatment should be aggressive, and treated to specific targets. Nutritional deficiencies should be treated first, and only once replete, should erythropoiesis-stimulating agents (EPO-stimulating agents [ESAs]) be considered. Careful consideration must be given to the adverse effects of ESAs, and prescribed only after discussion with the patient. Patients with refractory anaemia, rapidly deteriorating glomerular filtration rate (GFR), and who have stage 3-5 CKD should be referred timeously to a nephrologist.