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International treatment guidelines for anaemia in chronic kidney disease — what has changed?

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Balancing the risks and benefits of erythropoietin-stimulating agents and iron therapy

One in nine Australians has chronic kidney disease (CKD),1 although the condition may often not be recognised in primary care.2 There are five stages of CKD, ranging from Stage 1, in which patients have normal renal function but urinary abnormalities, structural abnormalities or genetic traits pointing to kidney disease, through to Stage 5, in which patients have end-stage disease.1

Although anaemia in patients with CKD is multifactorial in origin, it is primarily associated with relative erythropoietin production deficiency3 as the glomerular filtration rate (GFR) falls. Once the estimated GFR trends below 60 mL/min/1.73 m2 (Stage 3a CKD), erythropoietin production by the kidneys falls, and anaemia may develop.

The history of anaemia management in CKD and associated clinical practice guidelines has been one of contradiction and perceived industry influence.