Abstract
The article deals with pathophysiology and treatment of anaemia accompanying chronic kidney diseases (CKD). More detailed attention is given to physiology and pathophysiology of erythropoietin, the metabolism of iron it shortly overviews other factors which can be significant for development of anaemia (infectious processes, inflammatory conditions, some drugs, secondary hyperparathyroidism and tumours), while the significance of other factors is merely complementary (vitamin B12 deficit or folic acid deficit) or hypothetical (for example uraemic inhibitors of erythropoiesis).
In the 2nd part of the article, information is given about the new KDIGO recommendations for anaemia treatment in cases of CKD, which were published in August 2012. The new recommendations brought many changes affecting clinical practice, in comparison to the previous American (KDOQI, 2006) and European (ERBP, 2004) ones.
Newly recommended were higher serum levels of ferritin (500 µg/l) and for transferin saturation (30%). Erythropoiesis stimulating drugs (ESA) should be administered only following suitable supplementation of iron levels.
Another important change is the lower recommended Hb concentration for which an intervention using ESA is indicated. ESA should be administered should Hb be in the range of 90-100 g/l.
In patients with symptoms of the anaemic syndrome, ESA can be applied with Hb ? 100 g/l. It is generally recommended that during maintenance ESA therapy, the Hb level should not exceed 120 g/l in adult patients.
Other topics discussed in the article include the causes, diagnostics and treatment of hyporesponsiveness to ESA, pure red cell aplasia and the issue of giving blood transfusions to patients with CKD.