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
I would like to, first of all,
discuss the definition of anemia
in general population
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,
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.