🩸 CKD Anemia of Renal Disease Management
This tool manages anemia of CKD by hemoglobin and iron status (ferritin/TSAT) and dialysis modality, directing iron, ESA/HIF-PHI, and the Hb target.
Iron deficiency and reversible factors are corrected before starting an ESA, and an excessively rapid hemoglobin rise is avoided. (original synthesis · not guideline verbatim)
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When to use
Use to decide on iron supplementation, ESA or HIF-PHI initiation, and to keep hemoglobin within the target band while avoiding overshoot.
How it works
Iron deficiency: non-dialysis/PD SF < 100 or TSAT < 20%, hemodialysis SF < 200 or TSAT < 20%; SF > 500 no routine IV iron. Hb < 100 → start ESA/HIF-PHI; target Hb ≥ 110 and ≤ 130; avoid > 10 g/L rise in 4 weeks.
Key points
- Iron deficiency and reversible factors are corrected before starting an ESA, and an excessively rapid hemoglobin rise is avoided. (original synthesis · not guideline verbatim)
- Hemodialysis uses a higher ferritin threshold (SF < 200) than non-dialysis/PD (SF < 100).
- Hb > 130 prompts dose reduction because excessive levels raise thrombosis and death risk.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Hemoglobin Hb | 95 g/L |
|---|---|
| Serum ferritin SF | 120 ng/mL |
| Transferrin saturation TSAT | 18 % |
| Dialysis modality | Non-dialysis / peritoneal dialysis |
→DispositionStart anemia correction
- Iron status & supplementation：Iron deficiency present (non-dialysis/PD SF < 100 and/or TSAT < 20%): give iron first (oral or IV for non-dialysis, usually IV for dialysis; avoid IV iron in active infection/bacteremia)
- ESA/HIF-PHI：Start an erythropoiesis-stimulating agent (ESA, first-line) or HIF-PHI (roxadustat): correct iron deficiency and reversible factors (inflammation, bleeding, nutrition, etc.) and exclude other anemia causes first
- Target：Hb ≥ 110 and ≤ 130 g/L, individualized (age, dialysis modality, comorbidities); avoid a Hb rise > 10 g/L within 4 weeks
Frequently asked questions
- What is CKD Anemia of Renal Disease Management?
- This tool manages anemia of CKD by hemoglobin and iron status (ferritin/TSAT) and dialysis modality, directing iron, ESA/HIF-PHI, and the Hb target.
- How is CKD Anemia of Renal Disease Management calculated? What is the core formula?
- Iron deficiency: non-dialysis/PD SF < 100 or TSAT < 20%, hemodialysis SF < 200 or TSAT < 20%; SF > 500 no routine IV iron. Hb < 100 → start ESA/HIF-PHI; target Hb ≥ 110 and ≤ 130; avoid > 10 g/L rise in 4 weeks.
- When is CKD Anemia of Renal Disease Management used?
- Use to decide on iron supplementation, ESA or HIF-PHI initiation, and to keep hemoglobin within the target band while avoiding overshoot.
- What are the key clinical points for CKD Anemia of Renal Disease Management?
- Iron deficiency and reversible factors are corrected before starting an ESA, and an excessively rapid hemoglobin rise is avoided. (original synthesis · not guideline verbatim) Hemodialysis uses a higher ferritin threshold (SF < 200) than non-dialysis/PD (SF < 100). Hb > 130 prompts dose reduction because excessive levels raise thrombosis and death risk.
- What are the limits and cautions when using CKD Anemia of Renal Disease Management?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is CKD Anemia of Renal Disease Management calculated in practice? Can you show a worked example?
- Inputs: Hemoglobin Hb 95 g/L, Serum ferritin SF 120 ng/mL, Transferrin saturation TSAT 18 %, Dialysis modality Non-dialysis / peritoneal dialysis → Result: Disposition Start anemia correction（Iron status & supplementation: Iron deficiency present (non-dialysis/PD SF < 100 and/or TSAT < 20%): give iron first (oral or IV for non-dialysis, usually IV for dialysis; avoid IV iron in active infection/bacteremia), ESA/HIF-PHI: Start an erythropoiesis-stimulating agent (ESA, first-line) or HIF-PHI (roxadustat): correct iron deficiency and reversible factors (inflammation, bleeding, nutrition, etc.) and exclude other anemia causes first, Target: Hb ≥ 110 and ≤ 130 g/L, individualized (age, dialysis modality, comorbidities); avoid a Hb rise > 10 g/L within 4 weeks）