Chapter 1: Diagnosis and evaluation of anemia in CKD

BACKGROUND In any individual, anemia may be the initial laboratory sign of an underlying medical problem. Consequently, a complete blood count, including the hemoglobin (Hb) concentration, is routinely part of global health assessment in most adults, whether or not they have chronic kidney disease (CKD). In patients with CKD but stable kidney function, the appearance or progression of anemia may herald a new problem that is causing blood loss or is interfering with red cell production. The anemia should be evaluated independently of CKD stage in order to identify any reversible process contributing to the anemia. The causes of acquired anemia are myriad and too many to include in a guideline such as this. A comprehensive list of causes and the approach to diagnosis can be found in a standard textbook of medicine or hematology. The most commonly encountered reversible cause of chronic anemia or worsening anemia in CKD patients, other than anemia related directly to CKD, is iron deficiency anemia.