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Heba Youssef։ Anemia in CKD – It’s Not Just About Erythropoietin
Heba Youssef/LinkedIn
Jun 19, 2026, 11:45

Heba Youssef։ Anemia in CKD – It’s Not Just About Erythropoietin

Heba Youssef, Clinical Nutrition Pharmacist at Helwan General Hospital, shared a post on LinkedIn:

“Anemia in CKD: It’s Not Just About Erythropoietin

Every CKD patient with a falling hemoglobin deserves a proper workup – not just an ESA prescription.

Why it happens:

  • Reduced EPO production (the primary driver)
  • Iron deficiency – true or functional (increased hepcidin)
  • Chronic inflammation suppressing erythropoiesis
  • Shortened RBC survival from uremic toxins
  • Reversible causes: B12/folate deficiency, hypothyroidism, occult bleeding

The workup: CBC, reticulocyte count, ferritin, TSAT, B12/folate — always interpret ferritin alongside TSAT.

Management, in order:

  1. Correct reversible causes first
  2. Iron therapy per KDIGO 2026 thresholds – IV preferred in hemodialysis
  3. ESA therapy only after iron is optimized – target Hb less than 11.5 g/dL (never aim to normalize Hb; greater than or equal to 13 g/dL raises stroke, hypertension, and thromboembolism risk)
  4. Transfusion reserved for severe/symptomatic anemia or instability – minimize in transplant candidates

Pearl: Treat the cause, not just the number.

EPO deficiency is the mechanism – but iron status decides whether ESA therapy will even work.”

Heba Youssef։ Anemia in CKD - It's Not Just About Erythropoietin

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