ESA Hb Target in CKD — RACP Adult Medicine MCQ

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EasyNephrologyESA Hb Target in CKDRACP Adult Medicine

A 58-year-old man with diabetes and CKD stage 4 develops symptomatic anaemia (Hb 82 g/L). His ferritin is 450 µg/L and TSAT is 25% (iron replete). He is commenced on an ESA (darbepoetin). What Hb target should be aimed for?

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Correct answer: E — 100–115 g/L

KDIGO recommends an Hb target of 100–115 g/L when using ESAs in CKD. Normalisation of Hb (>130 g/L) with ESAs is associated with increased cardiovascular events and mortality (CREATE, CHOIR, TREAT trials). The lowest effective ESA dose should be used to maintain Hb within target. ESAs should NOT be commenced solely based on Hb – symptoms, transfusion dependence, and quality of life should guide initiation. Iron stores must be adequate before and during ESA therapy.

Reference: KHA-CARI – 2013 – Anaemia in CKD; KDIGO – 2012 – Anaemia Guidelines