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Anemia of chronic kidney disease — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Anemia of chronic kidney diseaseUSMLE Step 3

A 74-year-old man has progressive fatigue 4 months after starting hemodialysis. Hemoglobin is 8.8 g/dL, MCV is 89 fL, ferritin is 420 ng/mL, transferrin saturation is 28%, vitamin B12 is normal, and stool occult blood testing is negative. Blood pressure is 138/76 mm Hg. Which of the following is the most likely explanation for this patient's findings?

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Correct answer: D — Erythropoietin deficiency

Normocytic anemia in advanced chronic kidney disease with adequate iron stores is most commonly due to reduced renal erythropoietin production. ESA therapy may be considered after iron status and other causes are assessed.

Reference: KDIGO Anemia in Chronic Kidney Disease Guideline