Anemia is known to be a common and clinically important cause of chronic kidney disease (CKD). With progression of CKD, various factors can be attributed to reduction in hemoglobin (Hb) levels. However, reduced production of erythropoietin (EPO) due to impaired functioning of kidneys remains the central cause. The most effective treatment of anemia associated with CKD involves iron replacement and erythropoietic-stimulating agents (ESAs). Diagnosis of iron-deficiency anemia (IDA) in CKD patients is complicated due to the relatively poor predictive ability of routine serum iron indices such as ferritin and transferrin saturation. Invasive methods such as bone marrow iron stores or erythropoietic response to supplemental iron for detection of iron deficiency serve as the gold standard and are required for confirmation of diagnosis.
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