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Anemia of chronic kidney disease — ABIM Board MCQ

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ModerateHematology/OncologyAnemia of chronic kidney diseaseABIM Board

A 70-year-old with CKD stage 4 has stable normocytic anemia, adequate iron indices and vitamin B12, a low reticulocyte count and no evidence of bleeding or hemolysis. What mechanism most directly explains the anemia?

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Correct answer: A — Reduced renal erythropoietin production causing hypoproliferative erythropoiesis

The best answer is “Reduced renal erythropoietin production causing hypoproliferative erythropoiesis”. Advanced CKD reduces renal erythropoietin production and creates a hypoproliferative, usually normocytic anemia. Adequate iron and B12 and the absence of bleeding or hemolysis make the alternatives unlikely. Inflammation and shortened red-cell survival can contribute, but inadequate erythropoietin signaling is central.

Reference: KDIGO Anemia in CKD Guideline: https://kdigo.org/guidelines/anemia-in-ckd/