Skill Checkup: A 59-Year-Old Man With a 4-Year History of Non-Dialysis Chronic Kidney Disease Presents With Anemia

Vecihi Batuman, MD, FASN


September 09, 2022

For adults with CKD-ND and iron deficiency anemia who are not currently on iron or ESA therapy, such as the patient in this case, KDIGO guidelines recommend a 1- to 3-month trial of oral iron therapy for those with TSAT ≤ 30% and ferritin ≤ 500 ng/ml (r500 mg/l), if the goal of treatment is an increase in Hgb concentration without the need for an ESA regimen. Of note, all reversible causes of anemia (including iron deficiency and inflammatory states) should be addressed prior to initiation of ESA therapy.

TSAT and ferritin should be evaluated at a cadence of at least every 3 months during ESA therapy. Iron status should be monitored more frequently when initiating or increasing ESA dose, upon blood loss, when monitoring response after a course of IV iron, and in other clinical situations when iron stores are at risk for depletion.


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