Anaemia as a risk factor for chronic kidney disease

Anaemia is a risk factor for progression of chronic kidney disease (CKD). There is also a clear and consistent association between anaemia and cardiovascular risk in patients with CKD. Complete correction of anaemia by treatment with erythropoiesis-stimulating agents (ESAs) has not been shown to improve these outcomes in non-dialysis CKD patients. Anaemia plays a causal role in the pathobiology of left ventricular hypertrophy (LVH), but the beneficial effect of ESA therapy seems to be limited to CKD patients with severe anaemia. At present, target haemoglobin levels between 10 and 12 g/dl are considered for non-dialysis CKD patients but also in the dialysis patient population. Anaemia is also of clinical relevance and prognostic significance in patients with heart failure, particularly in those with heart failure and CKD. However, the ideal threshold at which anaemia corrections should be started and the optimal target haemoglobin levels for heart failure patients need to be determined.