Anemia of chronic kidney disease is more prevalent when GFR is under 60ml per minute as a consequence of loss of erythropoietin synthesis by the kidney. Target goals for treatment are hemoglobin levels of 12g per dL for males and 11g per dL for females. One randomized controlled trial in patients with chronic kidney disease without dialysis comparing erythropoietin treatment vs. placebo reported significant improvement in energy levels and work capacity in the treatment group. Iron supplementation is necessary for effective erythropoiesis. When there is inadequate response to rHu-EPO, folate and vitamin B₁₂, status should also be evaluated. There are limited long-term studies of the benefits of rHu-EPO in chronic kidney disease (non-dialysis).

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.