Diagnose anemia in children with CKD if Hb concentration is <11.0 g/dl in children 0.5–5 years, <11.5 g/dl in children 5–12 years, <12.0 g/dl in children 12–15 years, <13.0 g/dl in males and <12.0 g/dl in females >15 years.
For all pediatric CKD patients with anemia not on iron or ESA therapy, oral iron (or IV iron in HD patients) administration is recommended when TSAT is <20% and ferritin is <100 microgram/l.
For all children on ESA therapy who are not receiving iron supplementation, oral iron (or IV iron in HD patients) administration is recommended to maintain TSAT >20% and ferritin >100 microgram/l.
Evaluate iron status (TSAT and ferritin) at least every 3 months during ESA therapy, including the decision to start or continue iron therapy.
In children receiving ESA therapy Hb should be in the range of 11.0 to 12.0 g/dl.
Investigate and manage anaemia in CKD patients if haemoglobin (Hb) level falls to < 11.0 g/dL ( < 10.5 g/dL if younger than 2 years) or they develop symptoms attributable to anaemia (such as tiredness, shortness of breath, lethargy and palpitations).
Test for iron deficiency and determine potential responsiveness to iron therapy and long-term iron requirements every 3 months (every 1–3 months for haemodialysis patients).
Do not request transferrin saturation or serum ferritin measurement alone to assess iron deficiency in people with anaemia of CKD.
In people treated with iron, serum ferritin levels should not rise above 800 ug/L. In order to prevent this, review the dose of iron when serum ferritin levels reach 500 ug/L.
ESA (erythropoietic stimulating agent) therapy should not be initiated in the presence of absolute iron deficiency without also managing iron deficiency.
Dose and frequency of ESA should be adjusted to keep rate of Hb increase between 1 and 2 g/dL/month.
Target for Hb 10-12 g/dL for children aged 2 years and older, and between 9.5 and 11.5 g/dL for children younger than 2 years of age.
Comments by evaluators:
Different iron and ESA preparations are poorly described and discussed.