Anaemia and chronic kidney disease: New guidance
NICE updates guidance to reduce risk of strokes and other complications
9th February 2011 - The National Institute for Health and Clinical Excellence (NICE) is updating its guidance on treating anaemia in people with chronic kidney disease.
Doctors should review how they diagnose and monitor anaemia in these patients to reduce the risk of strokes and other health complications that may occur if the haemoglobin levels achieved by treating anaemia are too high.
This follows new evidence on the levels of haemoglobin that help doctors determine when patients with chronic kidney disease should receive treatment, as well as the safe target haemoglobin limits.
Chronic kidney disease (CKD)
CKD is an irreversible condition, strongly linked to high blood pressure and diabetes.
Moderate to severe CKD may affect the ability of the kidneys to help make red blood cells, which carry oxygen around the body.
Anaemia occurs when the quality or quantity of red blood cells are below normal. If untreated, anaemia can increase the risk of cardiovascular complications (such as an increasing strain on the heart) and make some symptoms worse - such as tiredness, lethargy, sleep disturbance and shortness of breath.
This can lead to increased hospital visits, impaired quality of life and in some cases, death.
New haemoglobin targets
In 2006, NICE advised healthcare professionals to maintain the haemoglobin levels of their patients with CKD between 10.5 and 12.5 g/dl for adults, teenagers and children aged two and above, and between 10 and 12 g/dl for children under two.
Further studies have since been published which indicate that having haemoglobin levels above 12 g/dl doesn’t bring any additional clinical benefit and may even possibly cause some health risks, including the risk of stroke.
In response, NICE is now advising healthcare professionals to maintain the haemoglobin range between 10 and 12g/dl for adults, teenagers and children over two years, and to between 9.5 and 11.5 g/dl for those under two.
NICE is also urging doctors to not wait until their patients’ haemoglobin levels are outside these ranges before adjusting their treatments - so they should act when their patient’s haemoglobin levels are within 0.5 g/dl of the range’s limit.
CKD safety concerns
In a statement, Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE says: “Anaemia in chronic kidney disease affects around 100,000 people nationally and can be very harmful. However, its side-effects can be kept at bay if managed properly.
“We have partially updated our clinical guideline on the management of anaemia in chronic kidney disease because of recently published evidence relating to optimum target haemoglobin levels. It is important that healthcare professionals in renal units acknowledge the subtle but important changes that we have made to these recommendations as they carry some very serious safety concerns.”
Dr Paul Stevens, a Consultant Renal Physician, helped update the guidelines. In a news release, he says: “The updated recommendations support the lower range highlighted in these studies, enabling clinicians to deliver the safest possible care for their patients.”