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CKD Anaemia — ESENeph MCQ

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EasyChronic Kidney DiseaseCKD AnaemiaESENeph

A 55-year-old man with CKD G5 (eGFR 9 mL/min/1.73m2) secondary to diabetic nephropathy has a haemoglobin of 88 g/L. His ferritin is 85 mcg/L and transferrin saturation (TSAT) is 16%. He is not yet on dialysis. What is the most appropriate next step?

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Correct answer: C — Intravenous iron replacement

KDIGO 2025 anemia guideline recommends treating iron deficiency before or alongside ESA therapy. Iron deficiency is defined as ferritin <100 mcg/L or TSAT <20% in non-dialysis CKD. IV iron is preferred in CKD G5 as oral iron is often poorly absorbed and poorly tolerated. ESAs should be considered only after iron stores are replete. Blood transfusion is avoided in potential transplant candidates.

Reference: KDIGO 2025 – Clinical Practice Guideline for Anemia in CKD