Skip to content
GERICLINICS

GeriQBank · Paper III · Q12

Anaemia of Chronic Kidney Disease — Type, Investigation & Treatment

Moderate YieldAsked ×17-mark note
Topic
Haematology, Oncology & Screening
Chapter
Haematology
Years asked
Not recorded in the source
Frequency
Set 1× in Paper III (2009–2025)

As set in the university paper

  • Anaemia of chronic kidney disease — type, investigation and treatment modalities.

    Paper III · Renal, Fluid & Electrolyte Disorders · asked ×1 · 7-mark note · see in paper list

Detailed answer

Pro · free in beta
Attempt it firstOutline your answer as a 7-mark note before revealing it — definition, causes, evaluation, management and the geriatric angle.Reveal answer

Treatment

Well covered: Pathy's Ch. 22, dedicated CKD section with Figure 22.3.

High-Yield Points

A. Type & Epidemiology

1.

Normocytic, normochromic, HYPOPROLIFERATIVE anaemia — reticulocytes low for the degree of anaemia.

2.

45–70% of adults over 75 meet CKD criteria (GFR<90); 51–60% of CKD nursing-home residents also anaemic. Hb<8 g/dL carries 2× mortality risk vs 10–11 g/dL.

B. Pathophysiology — Five Mechanisms

3.

EPO deficiency — dominant mechanism, most severe once CrCl<30 mL/min.

4.

Hepcidin excess — HIGHER than ordinary ACD because of reduced renal clearance of the peptide.

5.

Shortened RBC lifespan — uraemic toxins cut survival from 120 to 30–40 days.

6.

Increased blood loss — uraemic platelet dysfunction + dialysis/phlebotomy losses.

7.

Concurrent true iron deficiency very common.

C. Investigation

8.

Work up when Hb <12 g/dL (men), <11 g/dL (women) — per NKF.

9.

Serum EPO of limited value — may be normal/slightly high but inappropriately low for the anaemia.

10.

Same ferritin/sTfR algorithm as ACD; exclude B12/folate, TSH, PTH, occult bleeding.

D. Treatment

11.

Correct iron FIRST, then give ESA — enough free iron must be available for marrow use.

12.

Maintain ferritin ~200 ng/mL, TSAT >20% in dialysis; no benefit above ferritin ~500 ng/mL.

13.

Target Hb 11–12 g/dL — normal range must NOT be targeted (increased mortality from thrombosis).

14.

10–20% are ESA-hyporesponsive; ESAs linked to malignancy progression — do not treat the underlying disease.

Latest Updates (2023–Present) — KDIGO 2026

Pathy's cites KDOQI 2000/2006 — fully superseded. New terminology: "iron-restricted erythropoiesis" replaces "functional iron deficiency"; "systemic iron deficiency" replaces "absolute". Haemoglobin target LOWERED to BELOW 11.5 g/dL (Level 1 recommendation) — lower than Pathy's 11–12 g/dL. ESA initiation at Hb ≤9.0–10.0 g/dL in dialysis. Formal iron thresholds: start IV iron in HD if ferritin ≤500 ng/mL AND TSAT ≤30%; withhold if ferritin >700 ng/mL or TSAT ≥40%. HIF-PHIs now addressed but as SECOND-line (never combined with ESA); daprodustat FDA-approved 2023 with boxed thrombotic warning; roxadustat FDA-rejected. Transfusion now symptom-based, not threshold-based; avoid in transplant candidates.

Current Practice Update

Domain Pathy's (KDOQI-era) KDIGO 2026

Target haemoglobin 11–12 g/dL Below 11.5 g/dL — lowered Terminology "Functional iron deficiency" "Iron-restricted erythropoiesis"

New drug class Not mentioned HIF-PHIs — second-line only Transfusion Not detailed Symptom-based; avoid in transplant candidates MD Geriatrics – Haematology Compendium Page 25 of 34

How was your recall?

Rating marks the question complete. “Need another pass” also adds it to your bookmarks.

References

Spotted an error or something out of date?Report a problem with this page