Epidemiology and Etiology

Current NKF guidelines define anemia as a hemoglobin (Hgb) level less than 13.5 g/dL (135 g/L or 8.37 mmol/L) in males and less than 12 g/dL (120 g/L or 7.4 mmol/

L) in females. A number of factors can contribute to the development of anemia, including deficiencies in vitamin B12 or folate, hemolysis, bleeding, or bone marrow suppression. Many of these can be detected by alterations in RBC indices, which should be included in the evaluation for anemia. A complete blood cell count is also helpful in evaluating anemia to determine overall bone marrow function.

The prevalence of anemia correlates with the degree of kidney dysfunction. More than 26% of patients with a GFR greater than 60 mL/min/1.73 m are estimated to have Hgb levels less than 12 g/dL (120 g/L or 7.4 mmol/L), and the number increases

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to 75% in patients with a GFR less than 15 mL/min/1.73 m . The risk of developing anemia also increases as GFR declines, doubling for patients with stage 3 CKD, increasing to 3.8-fold in patients with stage 4 CKD, and to 10.5-fold for patients with stage 5 CKD, compared to stages 1 and 2 CKD.43

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