× NICE uses cookies to make the site better.  Learn more
A-Z
Topics
Latest


Anaemia management in people with chronic kidney disease

About

What is covered

This interactive flowchart covers diagnosing and managing anaemia in children, young people and adults with chronic kidney disease. The age groups defined in this flowchart are as follows:
  • children: 13 years and under
  • young people: 14 to 17 years
  • adults: 18 years and over.

Updates

Updates to this interactive flowchart

26 July 2017 Chronic kidney disease in adults (NICE quality standard 5) removed.
2 June 2015 Update on publication of anaemia management in chronic kidney disease (NICE guideline NG8).

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on managing anaemia in people with chronic kidney disease in an interactive flowchart

What is covered

This interactive flowchart covers diagnosing and managing anaemia in children, young people and adults with chronic kidney disease. The age groups defined in this flowchart are as follows:
  • children: 13 years and under
  • young people: 14 to 17 years
  • adults: 18 years and over.

Updates

Updates to this interactive flowchart

26 July 2017 Chronic kidney disease in adults (NICE quality standard 5) removed.
2 June 2015 Update on publication of anaemia management in chronic kidney disease (NICE guideline NG8).

Sources

NICE guidance and other sources used to create this interactive flowchart.

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

NICE has produced resources to help implement its guidance on:

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

People with anaemia of CKD should not have iron levels checked earlier than 1 week after receiving intravenous iron. The length of time to monitoring of iron status is dependent on the product used and the amount of iron given.
Routine monitoring of iron stores to prevent iron overload using serum ferritin should be at intervals of 1–3 months.

Diagnostic tests to determine iron status and predict response to iron therapy

Anaemia management in people with chronic kidney disease NG8 contains new recommendations on diagnostic tests (see diagnosis). The anticipated national savings of using the newly recommended tests are discussed in the costing statement. The increased use of percentage of hypochromic red blood cells (HRC) tests is likely to lead to more accurate diagnosis, as a result of the considerably higher sensitivity and specificity of HRC testing. The table below indicates test accuracy and estimated cost. This may be useful for clinicians in primary and secondary care responsible for requesting the recommended tests. It could also help to support a change to electronic pathology ordering systems and provide a rationale for purchasing new lab analysers. For further details, please see full guideline section 4.3.
Test strategy
Sensitivity
Specificity
Estimated laboratory charge per test (£)
Use percentage of hypochromic red blood cells (% HRC; more than 6% only if processing of blood sample is possible within 6 hours)
82%
95%
3.04
If using percentage of hypochromic red blood cells is not possible, use reticulocyte haemoglobin content (less than 29 pg) or equivalent tests, for example, reticulocyte haemoglobin equivalent.
57%
93%
4.71
If the above tests are not available or the person has thalassaemia or thalassaemia trait, use a combination of transferrin saturation (less than 20%) and serum ferritin measurement (less than 100 micrograms/litre).
Transferrin saturation
64%
6.18
Serum ferritin (SF) 39%
81%
5.11
Do not request transferrin saturation or serum ferritin measurement alone to assess iron deficiency status in people with anaemia of CKD.

Glossary

angiotensin-converting enzyme
chronic kidney disease
erythropoiesis-stimulating agent
erythropoiesis-stimulating agents
estimated glomerular filtration rate
General Medical Council's
haemoglobin
maximum of 2 infusions – for adults a minimum of 500 mg of iron in each infusion
percentage hypochromic red cells
more than 2 infusions – for adults typically a dose of between 100 to 200 mg of iron in each infusion
Medicines and Healthcare products Regulatory Agency
includes people with a failing transplant and people having conservative management
pure red cell aplasia
Healthcare delivered outside hospitals. It includes a range of services provided by GPs, nurses, health visitors, midwives and other healthcare professionals and allied health professionals such as dentists, pharmacists and opticians. It includes community clinics, health centres and walk-in centres.
Healthcare provided in hospitals. It includes accident and emergency departments, outpatient departments, antenatal services, genitourinary medicine and sexual health clinics.

Paths in this pathway

Pathway created: May 2011 Last updated: July 2017

© NICE 2017. All rights reserved. Subject to Notice of rights.

Recently viewed