Anaemia Investigation

Investigation of Anaemia in CKD Patients

In Chronic Kidney Disease (CKD) patients investigation for anaemia (anemia) has to be done proactively as anaemia in CKD patients is a fairly common occurrence. This article elaborates in detail the process of investigation that should be followed for patients on dialysis.

When to Investigate?

It is recommended to investigate patients for anaemia of CKD if their haemoglobin level falls below 13 g/dL (in men) & 12 g/dL (in women). Alternatively if they display any symptoms of anaemia such as tiredness or breathlessness, then too an investigation should be done.
This will involve ruling out other causes of anaemia, assessment of kidney function, assessment of any cardiovascular and other complications of anaemia or CKD.

How often to Investigate?

For CKD patients without anaemia:

• For CKD Stage 3 patients (GFR = 30-59 mL/min), Haemoglobin (Hb) levels should be tested at least once a year.
• For CKD Stage 4-5 patients (GFR < 30 mL/min), Hb levels should be tested twice every year.
• For patients on dialysis, Hb levels should be tested every 3 months at least.
• Or when patient shows symptoms of anaemia

For CKD patients with anaemia, but not treated with Erythropoietin Stimulating Agent (ESA):

• For CKD Stage 3 -5 patients who are not on dialysis, Hb should be tested at least once every 3 months
• For CKD Stage 5 patients, Hb should be measured every month.
• Or when patient displays symptoms of anaemia

For CKD patients with anaemia, who are receiving ESA

• During the correction phase, the test should be done every month.
• For CKD patients who are not on dialysis, test of Hb should be done every 3 months atleast
• For CKD patients undergoing dialysis, the test should be done every month
• Or when anaemia symptoms are observed.

Source: Anemia of chronic kidney disease: Protocol of study, management and referral to Nephrology on Nephrologia

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