Chronic Kidney Disease Pathway Document Description Presented ...

Stage 3
Management at stage 3 should include all of the interventions as
detailed for stages 1 and 2 plus the following section/s for stage 3.
Management of Anaemia
Lower levels of kidney function have been proven to be associated with lower
haemoglobin levels and a higher prevalence and severity of anaemia.This is
especially true in patients with diabetes and CKD. Anaemia can occur early in
the course of diabetic kidney disease and is associated with inappropriately low
erythropoietin concentrations 1 .
In patients with chronic renal disease, normochromic normocytic anaemia may
develop from decreased renal synthesis of erythropoietin. The anaemia becomes
more severe as the GFR decreases 2 . No reticulocyte response occurs, red blood
cell survival is decreased, and there is an associated increased bleeding
tendency due to uraemia-induced platelet dysfunction.
An eGFR of less than 60 ml/min (stage 3 onwards) should trigger investigation
into whether anaemia is due to CKD. When the eGFR is greater than or equal to
60 ml/min (stage 1 and 2) anaemia is more likely to be related to other causes 3 .
All patients at stage 3 CKD should have an annual measurement of
haemoglobin (Hb)
If the Hb is < 11 g/dl
Not all anaemia in patients with CKD will be ‘renal anaemia’ and causes of
anaemia other than CKD should be actively excluded before a diagnosis of
anaemia associated with CKD can be made 3 .
Other causes:
• Chronic blood loss
• Iron deficiency
• Vitamin B 12 or folate deficiency
• Hypothyroidism
• Chronic infection or inflammation
• Hyperparathyroidism (consider referral for assessment)
• Aluminum toxicity
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