Mehak Trehan: New Perspectives on Anemia Management in CKD
Mehak Trehan, Subject Matter Expert at DailyRounds, shared Annals of Internal Medicine‘s post on LinkedIn, adding:
“Its’ Anemia Week this time.
CKD anaemia: some important shifts in KDIGO 2026.
1. Don’t look at Hb alone. Ferritin plus TSAT should be part of routine assessment.
2. Iron thresholds are now clearer:
- Non-HD CKD: consider iron if ferritin less than 100 with TSAT less than 40%, OR ferritin 100-300 with TSAT less than 25%.
- Haemodialysis: IV iron preferred if ferritin equal to or less than 500 and TSAT equal to or less than 30%.
- Withhold routine iron if ferritin more than 700 or TSAT equal to or more than 40%.
3. Iron deficiency without anaemia matters: ferritin less than 30 plus TSAT less than 20% ‘may warrant treatment’ even with normal Hb.
4. ESA remains first line when pharmacologic treatment is needed. HIF-PHIs are an alternative not the default and should be avoided with active malignancy or recent cardiovascular or thrombotic events.
5. In dialysis, ESA initiation around Hb equal to or less than 9-10 g/dL is suggested; do not maintain Hb equal to or more than 11.5 g/dL.
For Indian practice:
This argues for moving beyond the common ‘low Hb – ESA’ approach.
Check iron properly, correct reversible causes first, and avoid escalating ESA for what may actually be iron-restricted erythropoiesis.
Particularly relevant where iron deficiency, inflammation, CKD and anemia frequently overlap.”
Annals of Internal Medicine shared a post on LinkedIn about a recent article by S. Susan Hedayati et. al, adding:
“Updated guidance from KDIGO recommends a more individualized approach to managing anemia in chronic kidney disease, including tailored treatment decisions, preferred use of IV iron for patients on hemodialysis, and addressing reversible causes before drug therapy.”
Title: Evaluation and Management of Anemia in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2026 Clinical Practice Guideline
Authors: S. Susan Hedayati, Jodie L. Babitt, Jeffrey S. Berns, Biykem Bozkurt, Rebecca S. Cheung, Yarieli Cuevas, Emmanuel E. Effa, Michele F. Eisenga, Steven Fishbane, Yelena Z. Ginzburg, Volker H. Haase, Siah Kim, Jose A. Moura-Neto, Patrick Rossignol, Manisha Sahay, Tetsuhiro Tanaka, Angela Yee-Moon Wang, David C. Wheeler, Karen A. Robinson, Lisa M. Wilson, Renée F. Wilson, Jennifer M. King, Amy Earley, Elie A. Akl, Marcello Tonelli, Evi V. Nagler
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