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Anaemia of CKD with iron deficiency — ESENeph MCQ

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ModerateRenal Bone Disease and Renal AnaemiaAnaemia of CKD with iron deficiencyESENeph

A 64-year-old woman with CKD G4 has fatigue. Haemoglobin is 88 g/L, ferritin 58 micrograms/L and transferrin saturation 14%. CRP is normal and B12 and folate are normal; there is no overt bleeding. What is the most appropriate management before erythropoiesis-stimulating therapy?

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Correct answer: E — Replete iron stores

CKD anaemia should be assessed for reversible contributors and iron deficiency corrected before or alongside ESA therapy. Starting ESA without iron repletion gives a poor response and may increase dose requirements. Routine transfusion is avoided when possible because of sensitisation risk, especially in potential transplant candidates. The pearl is that ferritin can be misleading in inflammation, so transferrin saturation helps assess iron availability.

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