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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 woman with chronic kidney disease stage 4 comes for anemia follow-up. Hemoglobin is 9.6 g/dL, ferritin is 180 ng/mL, transferrin saturation is 26%, B12 is normal, and stool occult blood testing is negative. She has fatigue but no chest pain. Blood pressure is 138/76 mm Hg. Which of the following is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Consider erythropoiesis-stimulating therapy after discussing risks and benefits

Anemia of advanced CKD with adequate iron stores may be treated with an erythropoiesis-stimulating agent when symptoms and hemoglobin level justify therapy, after shared decision-making about thrombotic and cardiovascular risks.

Reference: KDIGO anemia in chronic kidney disease guidance