Anaemia of chronic kidney disease

Anaemia is a common complication of chronic kidney disease. Aetiology is multifactorial, but a major factor is an inappropriately low production of erythropoietin in the peritubular cells of the kidney. Chronic anaemia causes quite a number of debilitating symptoms, particularly tiredness and lethargy, muscle fatigue, reduced exercise capacity, and breathlessness on exertion. There are adverse consequences to a number of physiological functions, particularly that of the heart. Most patients with anaemia solely related to renal impairment have a glomerular filtration rate <30 ml/minute, and anaemic patients with a lesser degree of renal impairment should be screened carefully for another cause of anaemia. Synthetic erythropoietin therapy has transformed the management of renal anaemia, inducing an increase in haemoglobin concentration, along with an improved quality of life and functional capacity. Many patients treated with erythropoietin will require supplemental iron, given intravenously. Newer agents for stimulating erythropoiesis are currently being developed, and several of these, including CERA and hematide, may be available within the next few years.