New York, NY — May 7, 2026 — The National Kidney Foundation (NKF) recently announced the publication of a new KDOQI (Kidney Disease Outcomes Quality Initiative) commentary on the 2026 Kidney Disease: Improving Global Outcomes clinical practice guideline for the management of anemia in chronic kidney disease (CKD). This commentary provides critical context for implementation in the United States.
Anemia remains a highly prevalent and serious complication of CKD, affecting millions of Americans and contributing to increased morbidity and mortality. The 2026 KDOQI clinical guideline emphasizes proactive iron therapy and cautious adoption of emerging therapies within individualized treatment decision-making. The commentary reflects on the latest scientific evidence about diagnostic and treatment approaches and offers practical guidance for clinicians managing this important component of dialysis and non-dialysis CKD.
“This commentary bridges global recommendations with real-world practice in the United States,” said lead author Dr. Diana Jalal, MD, University of Iowa. “It highlights both the advances in anemia management, and the complexities clinicians face in delivering safe, effective, and individualized care.” The senior author, Dr. Jay Wish, Indiana University added “Additionally, the commentary reflects on the recent evidence evaluating existing and emerging anemia therapies.”
Advancing Kidney Care Through Evidence-Based Guidance
The updated guideline reflects a decade of scientific progress since the prior guideline and integrates new research from key trials on iron therapies, erythropoiesis-stimulating agents, and hypoxia-inducible factor–prolyl hydroxylase inhibitors. It also highlights important gaps in knowledge and calls for further research to optimize anemia management in CKD care.
“Anemia management in CKD has evolved significantly,” said Kerry Willis, PhD, Chief Scientific Officer at NKF. “This guidance equips clinicians with practical insights to improve outcomes while navigating uncertainty and complexity in modern kidney care.”
Key Highlights from the KDOQI Commentary
The commentary emphasizes a shift toward more proactive management of iron in patients undergoing hemodialysis, supporting the use of intravenous iron to maintain stable iron levels and improve clinical outcomes when carefully monitored. This approach reflects growing evidence that proactive iron repletion can reduce complications, including cardiovascular events.
The guidance also discusses the importance of identifying and treating iron deficiency early, even in the absence of anemia, and especially in the presence of concomitant heart failure. Iron plays a critical role beyond hemoglobin production, influencing energy metabolism, muscle function, and cardiovascular health. Addressing iron deficiency at earlier stages may improve patient well-being and prevent downstream complications.
Erythropoiesis-stimulating agents remain the preferred first-line therapy for anemia in CKD, given their long-standing use and safety experience. While newer therapies such as hypoxia-inducible factor–prolyl hydroxylase inhibitors offer potential advantages, including improved iron utilization and oral administration, their long-term safety is less clear and their availability in the United States is limited.
The commentary also underscores the need to minimize reliance on red blood cell transfusions. Although transfusions can be lifesaving in certain clinical scenarios, they carry important risks, particularly for patients who may be candidates for kidney transplantation, where sensitization can affect transplant eligibility and outcomes.
Finally, the NKF strongly reinforces the Commentary’s support of individualized treatment decisions made through shared decision-making, considering the person’s symptoms, other conditions, treatment preferences, and potential risks and benefits of available therapies.
About Kidney Disease
In the United States, CKD remains an under-recognized public health burden that impacts 1 in 7 adults, and 90 percent of those affected are unaware of their condition. Approximately 1 in 3 U.S. adults are at risk for CKD, but less than 20% are assessed with guideline-recommended testing, eGFR and uACR. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, and family history. People of Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander descent are at increased risk for developing the disease. Black or African American people are about four times as likely as White people to develop kidney failure. Hispanic and Native American people experience kidney failure at approximately double the rate of White people.
About the National Kidney Foundation
The National Kidney Foundation is revolutionizing the fight to save lives by eliminating preventable kidney disease, accelerating innovation for the dignity of the patient experience, and dismantling structural inequities in kidney care, dialysis, and transplantation. For more information about NKF, visit www.kidney.org.
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Sam Tyler
National Kidney Foundation
Director of Professional and Scientific Communications
Phone: 202-279-1505
Email: sam.tyler@kidney.org