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Anaemia of CKD requiring ESA consideration — ESENeph MCQ

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ModerateRenal Bone Disease and Renal AnaemiaAnaemia of CKD requiring ESA considerationESENeph

A 67-year-old man with CKD G4 has normocytic anaemia. Haemoglobin is 96 g/L, ferritin 420 micrograms/L, transferrin saturation 31% and CRP is normal. B12, folate and thyroid function are normal; colonoscopy last year was normal. He remains symptomatic despite optimisation of iron status. What is the most appropriate management?

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Correct answer: C — Discuss erythropoiesis-stimulating agent therapy

Symptomatic anaemia of CKD with adequate iron status and exclusion of common reversible causes may be treated with ESA after discussion of risks and targets. Further intensive iron is unlikely to help when iron stores and TSAT are adequate. There is no evidence of haemolysis or autoimmune anaemia. The pearl is that ESA therapy aims to reduce symptoms and transfusion need, not to normalise haemoglobin.

Reference: NICE NG203; UK Kidney Association Anaemia of CKD Guideline