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CKD Anaemia Management — RACP Adult Medicine MCQ

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ModerateNephrologyCKD Anaemia ManagementRACP Adult Medicine

A 60-year-old man with CKD stage G4 (eGFR 22) has Hb 88 g/L. Iron studies: ferritin 250 μg/L, TSAT 18%. Reticulocyte count is low. B12 and folate are normal. EPO level is inappropriately low for the degree of anaemia. What is the most appropriate treatment?

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Correct answer: D — IV iron infusion THEN ESA if Hb remains <100

CKD anaemia with TSAT <20% (functional iron deficiency) despite ferritin 250 requires IV iron first (iron is needed for ESA to work effectively). KDIGO 2024: trial IV iron if TSAT <30% and ferritin <500 before ESA. If Hb remains <100 g/L after iron repletion (TSAT >20%, ferritin >200), commence ESA (darbepoetin or epoetin) targeting Hb 100-115 g/L (not >130 — increased cardiovascular risk per TREAT/CREATE trials).

Reference: KDIGO – 2024 – CKD Anaemia; KHA-CARI 2024