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Functional Iron Deficiency CKD — ESENeph MCQ

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ModerateChronic Kidney DiseaseFunctional Iron Deficiency CKDESENeph

A 48-year-old woman with CKD G3a (eGFR 55 mL/min/1.73m2) has haemoglobin of 95 g/L, ferritin 180 mcg/L, and TSAT 18%. She reports fatigue. According to KDIGO 2025, what is the appropriate iron management?

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Correct answer: E — IV iron replacement to achieve TSAT ≥20% and ferritin ≥200 before considering ESA

Although ferritin is 180 mcg/L, TSAT is only 18% indicating functional iron deficiency (reduced iron availability for erythropoiesis despite borderline-adequate stores). KDIGO 2025 anemia guideline recommends IV iron to optimise iron status before or alongside ESA therapy. In non-dialysis CKD, IV iron is preferred when oral iron is not tolerated or ineffective. Target TSAT ≥20% and ferritin ≥200 mcg/L in non-dialysis CKD.

Reference: KDIGO 2025 – Anemia in CKD Guideline