Monitoring of iron status and haemoglobin whilst on treatment for anaemia of CKD

Monitoring of iron status and haemoglobin whilst on treatment for anaemia of chronic kidney disease (CKD):

• iron levels
  • people with anaemia of CKD should not have iron levels checked earlier than 1 week after receiving intravenous iron
    • length of time to monitoring of iron status is dependent on the product used and the amount of iron given
  • routine monitoring of iron stores to prevent iron overload using serum ferritin should be at intervals of 1-3months
    
    
• monitoring haemoglobin levels
  • every 2-4 weeks in the induction phase of erythropoietin stimulating agent (ESA) therapy
  • every 1-3 months in the maintenance phase of ESA therapy
  • more actively after an ESA dose adjustment

ESAs: dose and frequency

• When correcting anaemia of CKD, the dose and frequency of ESA should be:
  
  
  • determined by the duration of action and route of administration of the ESA
    
    
  • adjusted to keep the rate of Hb increase between 10 and 20 g/litre/month

Notes:

• in people treated with iron, serum ferritin levels should not rise above 800 micrograms/litre. In order to prevent this, review the dose of iron when serum ferritin levels reach 500micrograms/litre

Reference:

NICE (June 2015). Anaemia management in people with chronic kidney disease