Executive Summary of the KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease (CKD)

Jodie L Babitt; Jeffrey S Berns; Biykem Bozkurt; Rebecca S Cheung Khedairy; Yarieli Cuevas; Emmanuel E Effa; Michele F Eisenga; Steven Fishbane; Yelena Z Ginzburg; Volker H Haase; S Susan Hedayati; Siah Kim; José A Moura-Neto; Evi V Nagler; Patrick Rossignol; Manisha Sahay; Tetsuhiro Tanaka; Angela Yee-Moon Wang; David C Wheeler; Karen A Robinson; Lisa M Wilson; Renee F Wilson; Amy Earley; Elie A Akl; Marcello Tonelli

doi:10.1016/j.kint.2025.06.005

Executive Summary of the KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease (CKD)

Kidney Int. 2026 Jan;109(1):44-56. doi: 10.1016/j.kint.2025.06.005.

Authors

Jodie L Babitt¹, Jeffrey S Berns², Biykem Bozkurt³, Rebecca S Cheung Khedairy⁴, Yarieli Cuevas⁵, Emmanuel E Effa⁶, Michele F Eisenga⁷, Steven Fishbane⁸, Yelena Z Ginzburg⁹, Volker H Haase¹⁰, S Susan Hedayati¹¹, Siah Kim¹², José A Moura-Neto¹³, Evi V Nagler¹⁴, Patrick Rossignol¹⁵, Manisha Sahay¹⁶, Tetsuhiro Tanaka¹⁷, Angela Yee-Moon Wang¹⁸, David C Wheeler¹⁹, Karen A Robinson²⁰, Lisa M Wilson²⁰, Renee F Wilson²⁰, Amy Earley²¹, Elie A Akl²², Marcello Tonelli²³

Affiliations

¹ Department of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA. Electronic address: Babitt.Jodie@mgh.harvard.edu.
² Renal Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Winters Center for Heart Failure, Cardiology Section, Baylor College of Medicine, Houston, Texas, USA.
⁴ Corporate and Foundation Relations, University of Washington Medicine, Seattle, Washington, USA.
⁵ Kidney Research Institute, Louisville, Kentucky, USA.
⁶ Department of Internal Medicine, University of Calabar, Calabar, Cross River State, Nigeria.
⁷ Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁸ Department of Medicine, Zucker School of Medicine at Hofstra, Great Neck, New York, USA; Department of Nephrology, Northwell Health, Great Neck, New York, USA.
⁹ Department of Hematology and Medical Oncology, Mount Sinai Hospital, New York, New York, USA.
¹⁰ Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹¹ Division of Nephrology, Stony Brook University School of Medicine, Stony Brook, New York, USA; Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹² Department of Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
¹³ Department of Medicine, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
¹⁴ Renal Division, Ghent University Hospital, Ghent, Belgium.
¹⁵ Université de Lorraine, INSERM, Centre d'Investigations Cliniques-Plurithématique 1433, INSERM Unit 1116, Centre Hospitalier Régional Universitaire (CHRU) de Nancy, and F-CRIN INI-CRCT, Nancy, France; Medical specialties and nephrology departments, Princess Grace Hospital, Monaco Private Hemodialysis Centre, and Monaco Clinical Research Infrastructure Network (M-CRIN), Monaco.
¹⁶ Department of Nephrology, Osmania Medical College and Hospital, Hyderabad, Telangana, India.
¹⁷ Department of Nephrology, Tohoku University, Sendai, Miyagi, Japan.
¹⁸ Department of Renal Medicine, Singapore General Hospital, Singapore; Duke-National University of Singapore (NUS), Singapore.
¹⁹ Department of Renal Medicine, University College London, London, United Kingdom.
²⁰ The Johns Hopkins University Evidence-Based Practice Center, Johns Hopkins University, Baltimore, Maryland, USA.
²¹ KDIGO, Brussels, Belgium.
²² Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.
²³ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: cello@ucalgary.ca.

PMID: 41485807
DOI: 10.1016/j.kint.2025.06.005

Abstract

The Kidney Disease: Improving Global Outcomes (KDIGO) 2026 Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease (CKD) represents an update to the guideline published in 2012. Its scope includes diagnosis and evaluation of anemia; use of iron to treat iron deficiency and anemia in CKD; use of erythropoiesis-stimulating agents and hypoxia-inducible factor-prolyl hydroxylase inhibitors to treat anemia in CKD; and red blood cell transfusions to treat anemia in CKD. The guideline has been developed with patient partners, healthcare providers, and researchers around the world, with the goal to generate a useful resource for healthcare providers and patients by providing actionable recommendations. The development of this guideline followed an explicit process of evidence review and appraisal based on systematic reviews. The certainty of evidence and strength of recommendations follows the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The guideline also provides practice points that provide clinical advice but are not supported by a systematic review. Limitations of the evidence are discussed. Research recommendations to address gaps in knowledge, and implications for policy and payment, are provided. The guideline targets a broad audience of healthcare providers, affected individuals, and stakeholders involved in the various aspects of anemia and CKD care.

Keywords: anemia; chronic kidney disease; dialysis; evidence-based; guideline; nondialysis.

Publication types

Practice Guideline

MeSH terms

Anemia* / diagnosis
Anemia* / etiology
Anemia* / therapy
Erythrocyte Transfusion / standards
Evidence-Based Medicine / standards
Hematinics* / therapeutic use
Humans
Hypoxia-Inducible Factor-Proline Dioxygenases / antagonists & inhibitors
Iron / therapeutic use
Nephrology* / standards
Renal Insufficiency, Chronic* / blood
Renal Insufficiency, Chronic* / complications
Renal Insufficiency, Chronic* / therapy

Substances

Hematinics
Hypoxia-Inducible Factor-Proline Dioxygenases
Iron