The National Institute for Health and Clinical Excellence (NICE) has published updated clinical guidelines for the management of anaemia in patients with chronic kidney disease (CG 114). The advice in the guideline covers:

• detecting and diagnosing anaemia of chronic kidney disease

• managing anaemia of chronic kidney disease, and other health problems or treatments that may affect it.

With respect to initiation of erythropoiesis-stimulating agent (ESAs) therapy in iron-deficient patients, the guideline makes the following recommendations:

• ESA therapy should not be initiated in the presence of absolute iron deficiency without also managing the iron deficiency.

• In people with functional iron deficiency, iron supplements should be given concurrently when initiating ESA therapy.

• In people treated with iron, serum ferritin levels should not rise above 800 micrograms/L. In order to prevent this, the dose of iron should be reviewed when serum ferritin levels reach 500 micrograms/L.

• In people with anaemia of CKD, androgens should not be used to treat the anaemia.

• People offered ESA therapy, and their GPs, should be given information about why ESA therapy is required, how it works, and what benefits and side effects may be experienced.

Please see link to the guideline for detailed information.