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IV Iron First-Line CKD Anaemia — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

HardChronic Kidney DiseaseIV Iron First-Line CKD AnaemiaESENeph

A patient starting maintenance haemodialysis has Hb 91 g/L, ferritin 170 micrograms/L and transferrin saturation 17%, with no active infection. ESA treatment is being considered. Which iron strategy best matches NICE guidance?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Offer intravenous iron and reassess iron status and haemoglobin response before escalating ESA dose

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

D is correct. NICE recommends intravenous iron for adults receiving haemodialysis; ongoing blood loss and dialysis logistics make parenteral replacement more reliable than oral therapy. Iron deficiency or restricted availability should be corrected and response reassessed before simply escalating ESA exposure. Ferritin alone is an imperfect inflammatory marker, so transferrin saturation, trends, clinical context and infection status are considered together. Transfusion is reserved for specific clinical indications because it carries sensitisation and other risks, especially in potential transplant candidates. The item asks for route and sequence, not an isolated ferritin threshold.

Reference: NICE NG8: chronic kidney disease anaemia: https://www.nice.org.uk/guidance/ng8/chapter/Recommendations