NICE Clinical Guideline 114: Anaemia Management in People with Chronic Kidney Disease
Core Recommendations:
- Investigate and manage anaemia in CKD patients if haemoglobin (Hb) level falls to < 11.0 g/dL ( < 10.5 g/dL if younger than 2 years) or they develop symptoms attributable to anaemia (such as tiredness, shortness of breath, lethargy and palpitations).
- Test for iron deficiency and determine potential responsiveness to iron therapy and long-term iron requirements every 3 months (every 1–3 months for haemodialysis patients).
- Do not request transferrin saturation or serum ferritin measurement alone to assess iron deficiency in people with anaemia of CKD.
- In people treated with iron, serum ferritin levels should not rise above 800 ug/L. In order to prevent this, review the dose of iron when serum ferritin levels reach 500 ug/L.
- ESA (erythropoietic stimulating agent) therapy should not be initiated in the presence of absolute iron deficiency without also managing iron deficiency.
- Dose and frequency of ESA should be adjusted to keep rate of Hb increase between 1 and 2 g/dL/month.
- Target for Hb 10-12 g/dL for children aged 2 years and older, and between 9.5 and 11.5 g/dL for children younger than 2 years of age.
Comments by evaluators:
- Different iron and ESA preparations are poorly described and discussed.