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CKD Anaemia — RACP Adult Medicine MCQ

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ModerateNephrologyCKD AnaemiaRACP Adult Medicine

A 65-year-old man with CKD stage 4 (eGFR 22 mL/min/1.73 m²) is found to have a haemoglobin of 88 g/L, ferritin 80 µg/L, and transferrin saturation 16%. What is the most appropriate management?

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Correct answer: C — IV iron followed by ESA if Hb remains <100 g/L

In CKD-associated anaemia, iron deficiency should be corrected first. With ferritin <200 µg/L and TSAT <20%, iron stores are inadequate. IV iron is preferred over oral iron in CKD (better absorption, fewer GI side effects). If haemoglobin remains <100 g/L after iron repletion, an ESA should be commenced with a target Hb of 100–115 g/L (not normalised, per KDIGO).

Reference: KHA-CARI – 2013 – Anaemia in CKD Guidelines; KDIGO – 2012 – Anaemia in CKD