Recommendations Updated for Management of Anemia in CKD

TUESDAY, Sept. 15, 2026 (HealthDay News) — In a clinical guideline published online Sept. 15 in the Annals of Internal Medicine, updated recommendations are presented for the management of anemia in chronic kidney disease (CKD).

S. Susan Hedayati, M.D., from the Stony Brook University School of Medicine in New York, and colleagues conducted a systematic evidence review and graded the certainty of evidence to update guidelines for management of anemia in CKD.

The guideline focuses on eight recommendations that were graded. Key points include transferrin saturation use and ferritin thresholds for guiding iron therapy, with intravenous iron preferred over oral iron in those receiving hemodialysis; addressing correctable causes of anemia prior to use of erythropoiesis-stimulating agents (ESAs) or hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs); use of an ESA as a first-line treatment instead of a HIF-PHI; individualized hemoglobin (Hb) thresholds, based on patient characteristics, symptoms, and values, for initiation of an ESA; and use of less than 11.5 g/dL as an upper target for Hb during ESA maintenance therapy. In addition, 49 practice points are included in the guideline, representing expert consensus where robust evidence was limited or systematic review could not be conducted.

“Important knowledge gaps remain to address the management of anemia in people with CKD,” the authors write. “Addressing these gaps will require large, well-designed randomized controlled trials and pragmatic trials across diverse settings and target populations.”

Abstract/Full Text