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ESA Hyporesponsiveness GI Blood Loss — ESENeph MCQ

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EasyHaemodialysisESA Hyporesponsiveness GI Blood LossESENeph

A 65-year-old man on haemodialysis has persistent anaemia (Hb 88 g/L) despite adequate iron stores and ESA therapy. He has occult GI blood loss confirmed on investigations – a large colonic polyp is found and removed. His anaemia improves. What is the key message regarding ESA hyporesponsiveness workup?

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Correct answer: A — Always investigate for occult blood loss as a cause of ESA hyporesponsiveness

KDIGO 2025 anemia guideline emphasises that ESA hyporesponsiveness requires systematic investigation. Occult blood loss (GI is the most common source in dialysis patients – from uraemic gastritis, angiodysplasia, polyps, or malignancy) should be actively sought. Other causes include chronic inflammation/infection, inadequate dialysis, hyperparathyroidism, aluminium toxicity, haemoglobinopathies, and pure red cell aplasia. Simply increasing ESA dose without investigation is inappropriate and risks cardiovascular harm.

Reference: KDIGO 2025 – Anemia in CKD Guideline