Recommendations updated for management of anemia in chronic kidney disease

16 Sep 2026, 01:20 · Medical Xpress

by Elana Gotkine

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In a clinical guideline published online Sept. 15 in the Annals of Internal Medicine, updated recommendations are presented for managing anemia in chronic kidney disease (CKD).

S. Susan Hedayati, M.D., of Stony Brook University School of Medicine in New York, and colleagues conducted a systematic evidence review and graded the certainty of evidence to update guidelines for managing anemia in CKD.

The guideline focuses on eight graded recommendations. Key points include the use of transferrin saturation and ferritin thresholds to guide iron therapy, with intravenous iron preferred over oral iron for those receiving hemodialysis; addressing correctable causes of anemia before using erythropoiesis-stimulating agents (ESAs) or hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs); using an ESA as a first-line treatment instead of a HIF-PHI; individualized hemoglobin (Hb) thresholds for initiating an ESA, based on patient characteristics, symptoms and values; and using less than 11.5 g/dL as an upper target for Hb during ESA maintenance therapy.

In addition, the guideline includes 49 practice points, representing expert consensus when robust evidence was limited or a systematic review could not be conducted.

"Important knowledge gaps remain to address the management of anemia in people with CKD," the authors write. "Addressing these gaps will require large, well-designed randomized controlled trials and pragmatic trials across diverse settings and target populations."

Publication details

S. Susan Hedayati et al, Evaluation and Management of Anemia in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2026 Clinical Practice Guideline, Annals of Internal Medicine (2026). DOI: 10.7326/annals-26-02326

Journal information: Annals of Internal Medicine

Key medical concepts

intravenous iron therapy

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