Recommendation ID
NG8/1
Question

Management of anaemia of chronic kidney disease with concurrent illness:- What is the optimal management (in terms of clinical and cost effectiveness) of anaemia of chronic kidney disease (CKD) in patients who are receiving erythropoietic stimulating agents (ESAs) and have a significant concurrent acute infectious illness?

Any explanatory notes
(if applicable)

Why this is important:- Chronic kidney disease is a risk factor for mortality in patients who develop acute illness. Acute illness in CKD patients is associated with development, or worsening, of anaemia.

The anaemia of end-stage renal disease is managed primarily with ESAs and intravenous iron. When CKD patients develop acute illness, their anaemia becomes difficult to control. Acute inflammatory response usually renders patients hyporesponsive to treatments for anaemia. In addition, intravenous iron might promote bacterial infection. Many patients may end up having a blood transfusion – in part because of the lack of established guidelines on managing anaemia in CKD patients with acute illness. Little is known about the relative safety of transfusion compared with parenteral iron therapy, with or without ESA therapy.

There is a need for long-term observational studies, as well as prospective randomised controlled trials to compare the effectiveness and safety of treating anaemia in acutely ill CKD patients with parenteral iron, erythropoiesis stimulating agents, blood transfusion or a combination of the 3 different therapies. A large epidemiological or cohort study is needed with a control group (for example, patients admitted to hospital as an emergency with an acute illness, but without anaemia).

The study should be adequately powered to detect factors predictive of important end points such as patient survival, deterioration of renal function, the need to initiate renal replacement therapy and prolonged hospital stay.


Source guidance details

Comes from guidance
Chronic kidney disease: managing anaemia
Number
NG8
Date issued
June 2015

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No