DIAGNOSIS OF IRON DEFICIENCY ANEMIA IN
NON-DIALYSIS-DEPENDENT CHRONIC KIDNEY DISEASE

Anemia Definition

The World Health Organization defines anemia as a hemoglobin (Hb) concentration of <12.0 g/dL in women and <13.0 g/dL in men

Anemia Definition

  • Coronary artery diseafalls to 12 g/dL in NDD-CKD. CBC (including red blood 1 cell indexes)
  • Reticulocyte count
  • Serum ferritin
  • Transferrin saturation
  • Folic acid
  • Vitamin B12
Nephrologists should become involved in management when Hb concentration falls to 12 g/dL in NDD-CKD.1
A medical history and physical exam can suggest IDA while a blood test will confirm presence of low iron levels.2

Diagnosis Considerations 3

A focused clinical assessment is required for an initial assessment of anemia in CKD.

Although relative erythropoietin deficit will typically be the main contributing factor, other causes should also be taken into account.

It is important to undertake a focused history, physical exam, and lab review.

As in anemia without kidney disease, a thorough search for indications of decreased erythrocyte production, hemolysis, sequestration, and bleeding is required.

Testing for occult blood loss and iron deficiency in individuals with CKD should be prioritized due to the high prevalence of these conditions in this population.

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REFERENCES:

  1. Fishbane S, Spinowitz B. Update on anemia in ESRD and earlier stages of CKD: Core curriculum 2018. American Journal of Kidney Diseases. 2018;71(3):423–435. doi:10.1053/j.ajkd.2017.09.026
  2. National Heart, Lung, and Blood Institute. Iron-deciency Anemia. Date updated March 2022. Date accessed August 2022. https://www.nhlbi.nih.gov/health/anemia/iron-deciency-anemia

  3. National Institute of Diabetes and Digestive and Kidney Diseases. Chronic Kidney Diseases Tests and Diagnosis. Date accessed August 2022. https://www.niddk.nih.gov/health-information/kidney-dis-
    ease/chronic-kidney-disease-ckd/tests-diagnosis