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ESA Hb Rise Rate Target — ESENeph MCQ

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EasyChronic Kidney DiseaseESA Hb Rise Rate TargetESENeph

A 55-year-old man with CKD G4 and anaemia is started on Darbepoetin alfa SC. After 4 weeks, his Hb has risen from 88 to 95 g/L. What is the expected rate of Hb rise with ESA therapy?

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Correct answer: E — Target Hb rise is approximately 10-20 g/L per month

KDIGO 2025 anemia guideline recommends a gradual Hb rise of 10-20 g/L per month with ESA therapy. Rises faster than 20 g/L per month are associated with increased cardiovascular events (hypertension, stroke, vascular access thrombosis) and should trigger ESA dose reduction. The rate is controlled by adjusting ESA dose. This patient's rise of 7 g/L in 4 weeks is slightly below the target rate – the dose may need a modest increase. Hb should be checked every 2-4 weeks during ESA initiation/dose adjustment, then monthly once stable.

Reference: https://guidelines.ukkidney.org