A 40-year-old man on haemodialysis for CKD has Hb 8.5 g/dL with normocytic normochromic red cells, normal iron stores, and low reticulocyte count. The primary pathophysiological mechanism of anaemia of chronic kidney disease is:
- A Haemolysis from uraemic toxins damaging the red cell membrane
- B Iron sequestration by elevated hepcidin
- C Deficient erythropoietin production by diseased kidneys ✓
- D Folate loss in dialysate causing megaloblastic suppression
Correct answer: C. Deficient erythropoietin production by diseased kidneys
Explanation
The dominant mechanism of anaemia in CKD is deficient erythropoietin (EPO) synthesis by damaged peritubular interstitial cells, leading to inadequate erythroid stimulation and a hypoproliferative, normocytic normochromic anaemia with low reticulocyte count. Hepcidin elevation and functional iron deficiency are contributing but secondary mechanisms. Haemolysis is not a major factor in CKD anaemia. Folate loss may contribute marginally but is not the primary mechanism.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
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