In chronic kidney disease, anemia is primarily due to which of the following?

• A. Decreased erythropoietin production
• B. Increased RBC production
• C. Iron deficiency alone
• D. Vitamin B12 deficiency

Answer: (A)

Chronic kidney disease causes anemia mainly because the kidneys aren’t making enough erythropoietin, the hormone that signals the bone marrow to produce red blood cells. Erythropoietin is released in response to low oxygen levels, but damaged kidneys lose this ability, so red blood cell production drops and reticulocyte counts fall. This creates a normocytic, normochromic anemia that often accompanies CKD. Iron deficiency or vitamin B12 deficiency can worsen anemia in general, but they aren’t the primary mechanism in CKD. Treatment often includes addressing iron stores if needed and using erythropoiesis-stimulating agents to replace the missing hormone.