A 72-year-old woman with stage 4 chronic kidney disease (eGFR 18 mL/min/1.73m²) reports feeling exhausted with minimal exertion and notices she becomes short of breath when climbing one flight of stairs. Her laboratory results show hemoglobin 8.2 g/dL, hematocrit 25%, MCV 88 fL, and serum ferritin 210 ng/mL. On assessment, the nurse notes pale conjunctivae, tachycardia at rest, and the client states, "I just assumed this was normal for my age." Which finding best explains the underlying mechanism causing this client's anemia?
- Iron deficiency caused by poor dietary intake and malabsorption in the gastrointestinal tract
- Hemolysis of red blood cells due to uremic toxin accumulation in the bloodstream
- Vitamin B12 deficiency resulting from impaired absorption in the terminal ileum
- Decreased erythropoietin production by the damaged kidneys leading to reduced red blood cell synthesis