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CKD anaemia – iron first — RACP Paediatrics MCQ

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EasyNephrologyCKD anaemia – iron firstRACP Paediatrics

A 10-year-old with CKD stage 3 (eGFR 35 mL/min/1.73m²) has a haemoglobin of 85 g/L. Iron studies show low ferritin and low transferrin saturation. What is the most appropriate initial treatment for the anaemia?

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Correct answer: B — Iron supplementation

Iron deficiency should be corrected before starting ESAs in CKD-associated anaemia. Oral or IV iron supplementation is the first step. If haemoglobin remains <100 g/L despite iron repletion, erythropoiesis-stimulating agents (EPO, darbepoetin) should be initiated. Target Hb in CKD is typically 100-115 g/L.

Reference: RCH Melbourne – 2023 – CKD CPG; KDIGO – 2024 – CKD Anaemia Guidelines