Annals of Internal Medicine· 2026Q1
Evaluation and Management of Anemia in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2026 Clinical Practice Guideline
- 1citations
- Q1SCImago
- 2026year
Short summary
The 2026 KDIGO guideline recommends using transferrin saturation and ferritin thresholds to guide iron therapy, preferring IV iron for hemodialysis patients, and suggests ESAs over HIF-PHIs as first-line treatment for anemia in CKD.
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Key points
- Iron therapy for CKD anemia should be guided by transferrin saturation and ferritin thresholds.
- Intravenous iron is preferred over oral iron for patients receiving hemodialysis.
- Correctable causes of anemia must be addressed before starting ESAs or HIF-PHIs.
- ESAs are recommended as the first-line treatment over HIF-PHIs.
- Hemoglobin targets for ESA initiation should be individualized, with an upper maintenance limit below 11.5 g/dL.
AI-generated from the title and abstract; the full text is not read.
Abstract
DESCRIPTION: The Kidney Disease: Improving Global Outcomes (KDIGO) 2026 Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease (CKD) provides an update of the 2012 version. Its scope includes anemia diagnosis and use of iron therapy, erythropoiesis-stimulating agents (ESAs), hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs), and red blood cell (RBC) transfusions to treat anemia in CKD. METHODS: An international work group of patient partners, health care professionals, researchers, and clinicians defined the guideline scope. An independent evidence review team conducted systematic reviews through October 2024 and graded the certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. The final guideline incorporated feedback from a public review involving registered stakeholders in late 2024. RECOMMENDATIONS: This synopsis focuses on the 8 graded recommendations. Key points include the use of transferrin saturation and ferritin thresholds to guide iron therapy, with intravenous iron preferred over oral iron in people receiving hemodialysis; addressing correctable causes of anemia before use of an ESA or a HIF-PHI; using an ESA rather than a HIF-PHI as first-line treatment; individualized hemoglobin (Hb) thresholds for ESA initiation based on patient characteristics, symptoms, and values; and an upper Hb target of below 11.5 g/dL (<115 g/L) during ESA maintenance therapy. The guideline also includes 49 practice points representing expert consensus where robust evidence was limited or systematic review could not be conducted.
The authors' abstract, as published at the source. Annals of Internal Medicine, 2026 · DOI ↗
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Field: Hematology
HematologyMedicine