Biomarkers for Assessing and Managing Iron Deficiency Anemia in Late-Stage Chronic Kidney Disease Executive Summary

Chronic kidney disease (CKD) is the gradual, progressive deterioration of kidney function, and a condition that affects an estimated 26 million American adults. A common complication of CKD is anemia, which results from inadequate erythropoietin or from iron deficiency as a result of inadequate absorption or mobilization. The management of anemia in CKD patients must strike an appropriate balance between stimulating generation of erythroblasts (erythropoiesis) and maintaining sufficient iron levels for optimum hemoglobin (Hb) production.1 Erythropoietic stimulating agents (ESAs) mobilize iron stores in promoting erythropoiesis; however, decreased iron stores or iron availability are the most common reasons for resistance to the effect of ESAs. Thus, most patients who receive ESA treatment will require supplemental (oral or intravenous) iron to ensure an adequate response with erythropoietic agents. Iron management (iron status assessment and iron treatment), therefore, is an essential part of the treatment of anemia associated with CKD,1 as there remain outstanding Effective Health Care Program