Anaemia in chronic kidney disease

Published on September 29, 2016   29 min

Other Talks in the Series: The Kidney in Health and Disease

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Hello, my name is Iain Macdougall. I'm a Consultant Nephrologist and Professor of Clinical Nephrology in the Renal Unit, King's College Hospital in London. I've been invited to talk to you in this presentation about Anemia in Chronic Kidney Disease, a topic that I've had a long-standing clinical and research interest over the last two or three decades.
The topics I would like to cover specifically in relation to this presentation are six-fold. I would like to, first of all, discuss the definition of anemia in general population and specifically in chronic kidney disease. I would like to look at the prevalence of anemia in this patient population. I would like to discuss the causes of the condition, how to treat it, and specifically what the benefits and possible harms associated with treating anemia might be, and then just a brief word at the end about the future of CKD anemia management.
So I will start with the definition of anemia. In the general population, the things are quite well-defined according to the World Health Organization definition of anemia which was first talked about in the 1960s and is still quoted to today. So in men, anemia is defined by the World Health Organization as hemoglobin concentration of less than 13 gram per deciliter or in modern parlance 130 grams per liter. Women generally have lower hemoglobin, and according to the World Health Organization, their anemia is defined as a hemoglobin less than 12 grams per deciliter or in modern parlance 120 gram per liter. The reason for this discrepancy is often thought to be the fact that young women menstruate monthly and that is definitely part of the reason for this, but also recognized that testosterone plays a major part in red cell development. And, of course, men have higher levels of testosterone than women, so that's one of major reasons why men have higher hemoglobin generally than women. In the field of chronic kidney disease, things are slightly different, and the threshold hemoglobin for chronic kidney disease, both men and women is a hemoglobin less than 11 gram per deciliter or 110 gram per liter. The reasons for this are largely related to the thresholds for treatment and also the fact that this is a chronic anemia and patients with this condition with renal disease adapt to having lower hemoglobin levels and therefore it's accepted that the definition of anemia is lower than in the general population.