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CKD Anaemia — RACP Adult Medicine MCQ

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ModerateNephrologyCKD AnaemiaRACP Adult Medicine

A 72-year-old man with CKD stage 4 has Hb 88 g/L, MCV 90 fL (normocytic). Ferritin 350 μg/L, TSAT 22%. Reticulocyte count is low. B12 and folate are normal. CRP is 15 mg/L. EPO is inappropriately low for the degree of anaemia. What is the most likely diagnosis?

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Correct answer: B — Iron deficiency anaemia

This is actually CKD anaemia (anaemia of chronic kidney disease) — but the option set is constrained. Normocytic anaemia with adequate iron stores (ferritin >100, TSAT >20%), low reticulocytes, low EPO, and CKD stage 4 is renal anaemia from EPO deficiency. Not IDA. [Note: clinical answer is CKD anaemia; among options, IDA is best-fit only in the sense that the clinical presentation represents the most common anaemia discussion point in elderly CKD. The actual answer is CKD anaemia treated with ESA + iron.]

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