Worsening anaemia is a feature of chronic kidney disease (CKD) once the glomerular filtration rate falls below 60 mL/minute. It causes fatigue and impaired quality of life and may increase damage to the heart.
The major cause of renal anaemia is deficiency of erythropoietin (Epo), which is produced in the kidneys. Contributing factors include shortened red cell lifespan, inflammation, impaired release of iron from body stores and blood loss during haemodialysis. Most patients with severe CKD and symptomatic anaemia respond well to treatment with ESAs such as rHuEpo (see Chapter 6) and these can eliminate the need for blood transfusion. Parenteral iron supplements are often required to produce a full response. Because of the risk of hypertension and thrombotic complications with higher haematocrit levels, patients must be carefully monitored and the ESA dose adjusted to obtain maximum improvement in quality of life while avoiding Hb levels above 120 g/L. Successful renal transplantation corrects the anaemia of CKD.