Are haemoglobin levels adequate in patients with chronic kidney disease (CKD) stage 2-4?

J Ren Care. 2013 Dec;39(4):194-9. doi: 10.1111/j.1755-6686.2013.12016.x. Epub 2013 Jun 18.


Background: Anaemia often goes unrecognised in people with early chronic kidney disease (CKD) resulting in under treatment until reaching the need for dialysis.

Objectives: This study aimed to determine if anaemia is adequately treated in Australians with CKD, who do not require dialysis.

Design and measurement: Haemoglobin, ferritin and transferrin saturation (TSAT) data for patients with Stage 2-4 CKD were extracted from the Renal Anaemia Management database for the period 1999-2010. The data were compared with the target levels specified in the Caring for Australasians with Renal Impairment guidelines.

Results: Less than 50% of the patients achieved the recommended haemoglobin levels, and even fewer patients achieved the levels recommended for ferritin and TSAT.

Conclusion and application to practice: More emphasis should be placed on detection and treatment of anaemia in earlier stages of kidney disease. Poor response to erythropoiesis stimulating agent therapy should be investigated in this group and any identified causes of poor response treated.

Keywords: Anaemia; Chronic kidney disease; Erythropoiesis stimulating agents (ESA); Haemoglobin; Pre-dialysis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anemia / blood*
  • Anemia / nursing*
  • Anemia / therapy
  • Cardio-Renal Syndrome / blood
  • Cardio-Renal Syndrome / nursing
  • Cardio-Renal Syndrome / prevention & control
  • Comorbidity
  • Diabetic Nephropathies / blood
  • Diabetic Nephropathies / classification
  • Diabetic Nephropathies / nursing
  • Diabetic Nephropathies / therapy
  • Female
  • Ferritins / blood
  • Glomerular Filtration Rate / physiology
  • Hemoglobinometry*
  • Humans
  • Kidney Failure, Chronic / blood*
  • Kidney Failure, Chronic / classification
  • Kidney Failure, Chronic / nursing*
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • New South Wales
  • Practice Guidelines as Topic
  • Reference Values
  • Transferrin / metabolism


  • Transferrin
  • Ferritins