Evaluation and Management of Anemia in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2026 Clinical Practice Guideline

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.

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Publication Details

Journal
Annals of Internal Medicine
Published
2026-09-14
DOI
https://doi.org/10.7326/annals-26-02326
Citations
1
Primary Topic
Erythropoietin and Anemia Treatment
Type
article
Field-Weighted Citation Impact
5.87
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article

Evaluation and Management of Anemia in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2026 Clinical Practice Guideline

Yelena Ginzburg, Biykem Bozkurt, Lisa M Wilson, Rebecca Cheung et al.
1 citations
Annals of Internal Medicine
Erythropoietin and Anemia Treatment
5.87
article

Evaluation and Management of Anemia in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2026 Clinical Practice Guideline

Yelena Ginzburg, Biykem Bozkurt, Lisa M Wilson, Rebecca Cheung, Marcello Tonelli, Siah Kim, Manisha Sahay, Jodie L. Babitt, Emmanuel Effa, S. Susan Hedayati, Angela Yee‐Moon Wang, Amy Earley, David C. Wheeler, Volker H. Haase, Karen A. Robinson, Evi Nagler, Michele F. Eisenga, Steven Fishbane, Emmanuel E. Effa, José A. Moura-Neto, Renée F. Wilson, Jennifer M. King, Patrick Rossignol, Jeffrey S. Berns, Tetsuhiro Tanaka, Elie A. Akl
article en
1 citations

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.

Annals of Internal Medicine
Tohoku Institute of Technology (JP), Escola Bahiana de Medicina e Saúde Pública (BR), University Medical Center Groningen (NL), Hofstra University (US), Johns Hopkins University (US), Inserm (FR), University of Calgary (CA), Baylor College of Medicine (US), University of Washington (US), Tohoku University (JP), Singapore General Hospital (SG), Hospital of the University of Pennsylvania (US), Kidney Research UK (GB), Princess Grace Hospital Centre (MC), Ghent University Hospital (BE), Osmania General Hospital (IN), Children's Hospital at Westmead (AU), University of Cross River State (NG), University of Calabar (NG), Massachusetts General Hospital (US), Tohoku University Hospital (JP), Mount Sinai Hospital (US), VA Tennessee Valley Healthcare System (US), American University of Beirut Medical Center (LB), Fundação Bahiana de Infectologia (BR), Belgian Health Care Knowledge Centre (KCE) (BE), National University Hospital (SG), University College London (GB), The University of Texas Southwestern Medical Center (US), Vanderbilt University Medical Center (US), American University of Beirut (LB), Osmania Medical College (IN)
Openalex Percentile: Top 3%
Erythropoietin and Anemia Treatment
5.87
DOISourceOpenAlex
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