Anaemia in chronic kidney disease
Why CKD causes anaemia, the work-up that excludes other causes, iron first by the KDIGO 2026 thresholds, when an ESA is started and the 115 g/L ceiling, and why transfusion is avoided in transplant candidates.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Anaemia becomes common once eGFR falls below about 45 (G3b) and affects most patients on dialysis. KDIGO 2026 keeps the WHO definition: Hb under 130 g/L in men, under 120 g/L in women.
- It is normocytic and hypoproliferative, from erythropoietin deficiency and hepcidin-driven iron restriction. The mechanisms and drug details are in ESAs, IV iron and potassium binders.
- Sequence: exclude other causes, replete iron, then consider an ESA. Keep Hb below 115 g/L on treatment.
Loading the rest of the note…
Finished reading?
Sources
- KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease. Kidney International 2026;109(1S):S1-S99Kidney Disease Improving Global Outcomes, 2026 (published January 2026, replaces the 2012 guideline)
- Babitt JL et al. Executive summary of the KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease (CKD). Kidney Int 2026;109(1):44-56Kidney International, 2026
- Del Vecchio L et al. KDIGO 2026 Clinical Practice Guideline for Anemia in CKD: a commentary from the European Renal Best Practice (ERBP). Nephrol Dial Transplant 2026;41(8):1554-72Nephrology Dialysis Transplantation, 2026
- KHA-CARI Guidelines (Dialysis: haemoglobin, 2011; Dialysis: iron, 2013; commentary on KDIGO anaemia guideline, 2013)AU/NZKidney Health Australia, Caring for Australasians with Renal Impairment, online, checked November 2026 (no newer anaemia guideline found)
- Chronic Kidney Disease (CKD) Management in Primary Care, 5th editionAU/NZKidney Health Australia, 2024
- Macdougall IC et al. Intravenous iron in patients undergoing maintenance hemodialysis (PIVOTAL). N Engl J Med 2019;380:447-58New England Journal of Medicine, 2019
- Pfeffer MA et al. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease (TREAT). N Engl J Med 2009;361:2019-32New England Journal of Medicine, 2009
- PBS item 5637Q: darbepoetin alfa, Section 100 HSD (public), Authority Required (Streamlined), anaemia associated with intrinsic renal disease (epoetins listed the same way)AU/NZPharmaceutical Benefits Scheme, Australian Government, checked November 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback