HESI Chronic Kidney Disease Practice Test 2026 – Complete Exam Prep

In CKD-related anemia, the main issue is decreased erythropoietin, but red blood cell production also depends on having enough iron. Starting an erythropoiesis-stimulating agent without confirming iron availability is unlikely to succeed, and iron given without checking stores can lead to unnecessary treatment or overload.

The best initial step is to assess iron status with iron studies—typically ferritin to gauge stored iron and transferrin saturation (TSAT) to gauge circulating iron. If iron stores are adequate, an ESA can be used to stimulate erythropoiesis. If iron is deficient, iron therapy should be given to replenish stores before or alongside ESA therapy. This approach optimizes response and minimizes risks, including transfusion, iron overload, and ESA resistance.