Management of Anemia of Renal Failure

With the rising burden of non-communicable diseases and increased longevity, the prevalence of chronic kidney disease (CKD) has surged globally. Anemia, a common and debilitating complication of CKD, significantly contributes to morbidity and mortality. The pathogenesis is multifactorial, primarily involving inadequate erythropoietin production and iron dysregulation. This chapter delineates the epidemiology, diagnostic framework, and current management strategies of anemia in CKD. Special emphasis is placed on distinguishing between absolute and functional iron deficiency, in alignment with the latest KDIGO guidelines. The utility of various iron formulations, indications for erythropoiesis-stimulating agents (ESAs), and emerging therapies like HIF prolyl hydroxylase inhibitors (HIF-PHI) are reviewed in depth. Blood transfusion—while limited in scope—retains a role in specific clinical contexts. Through a case-based approach and evidence-backed recommendations, this chapter aims to guide hematologists in optimizing anemia care in CKD.