This National Institute for Health and Care Excellence (NICE) guideline covers diagnosing, assessing, managing and monitoring anaemia in people with chronic kidney disease. It aims to improve care for people with chronic kidney disease by specifying how to assess when their anaemia needs treating, and by making detailed recommendations on treatment with erythropoietic stimulating agents (ESAs) and iron. It also covers detecting and managing ESA-resistant anaemia.
The guideline development group for this 2015 update considered the evidence in several areas that provide challenges for clinicians managing anaemia of CKD. Recombinant human erythropoietin (also called EPO, an erythropoietic stimulating agent or ESA) for treating anaemia of CKD is an important tool in managing the condition. But some CKD patients with anaemia who are offered an ESA are 'ESA resistant' – that is, their condition consistently fails to respond to the ESA treatment. These patients often receive large doses of ESA, sometimes with blood transfusion, with limited benefits and at significant cost to the NHS. Many CKD patients with anaemia receiving an ESA are admitted with an intercurrent illness – such as pneumonia – which may temporarily render them acutely hyporesponsive to that ESA. There is uncertainty about the management of these groups of patients, and these areas were considered in the update. The update once again highlighted the often limited trial evidence in nephrology, compared with other specialities.
Over the past decade attention has shifted to the role and management of iron deficiency in anaemia of CKD. In CKD patients there is often a complex inflammatory state that makes it difficult to diagnose iron deficiency when using its standard markers, such as serum iron, serum total iron binding capacity or ferritin. In recent years evidence has been published on newer markers of iron deficiency and intravenous iron preparations. In this 2015 update, the guideline development group reassessed the diagnosis and management of iron deficiency in CKD, and made several recommendations in these areas.
You can read the guideline on NICE's website.