Skill Checkup: A 59-Year-Old Man With a 4-Year History of Non-Dialysis Chronic Kidney Disease Presents With Anemia

Vecihi Batuman, MD, FASN


September 09, 2022

Iron deficiency anemia in CKD is characterized by low erythropoietic activity, which reflects insufficient EPO stimulation. In this setting, pathophysiology involves decreased renal synthesis of EPO and iron deficiency, owing to both low iron stores and also relative iron deficiency caused by inflammation. Because CKD causes progressive inflammation, patients with more advanced disease tend to develop functional iron deficiency. Inflammation prompts the release of hepcidin, thereby reducing gastrointestinal iron absorption while increasing mobilization of stores in the reticuloendothelial system.

Anemia in the setting of CKD is also hypoproliferative, and often both normochromic and normocytic, making the condition a morphological mimic of anemia of chronic disease.


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