Synopsis
Confirm renal anaemia without diagnostic anchoring, correct iron restriction, select erythropoiesis-stimulating therapy safely, and balance transfusion, cardiovascular and transplant-sensitisation risks.
- CKD anaemia is usually normocytic and hypoproliferative, driven by inadequate erythropoietin response, inflammation, iron restriction and shortened red-cell survival.
- Do not attribute anaemia to kidney disease solely from a reduced eGFR; blood loss, iron deficiency, B12 or folate deficiency, haemolysis and marrow disease still require assessment.
- Check full blood count, reticulocytes, ferritin and transferrin saturation, with CRP and clinical context because ferritin rises during inflammation and may mask unavailable iron.
Key red flags
Rapid decline, bleeding, fragments, leucopenia, thrombocytopenia or marked macrocytosis requires urgent investigation beyond CKD.
Investigation priorities
Confirm phenotype and detect competing marrow or haemolytic disease.
Management branches
Haemoglobin falls below the reference range in a person with CKD.
- Review tempo, symptoms, bleeding, medicines and dialysis losses and obtain count, reticulocytes, film, iron indices, B12 and folate.
- Investigate gastrointestinal or gynaecological loss, inflammation, haemolysis and marrow disease when indices, trajectory or other cell lines are not typical.
Key medicines
Intravenous ironThe renal service calculates product-specific elemental iron and gives divided or total-dose infusions within licensed limits, haemodialysis timing and current ferritin and transferrin-saturation thresholds.
Epoetin alfaUse a renal-protocol subcutaneous or intravenous starting dose and interval, then titrate no more often than recommended according to haemoglobin trajectory, dialysis and individual response.