CDN Renal Pharmacology for Dialysis Nurses 1 — Questions and Answers
Question 1: Which erythropoiesis-stimulating agent (ESA) is most commonly used to treat anemia of chronic kidney disease in dialysis patients?
- Darbepoetin alfa
- Epoetin alfa (Correct answer)
- Romiplostim
- Filgrastim
Correct answer: Epoetin alfa
Epoetin alfa is the most widely used ESA for dialysis-associated anemia, stimulating bone marrow production of red blood cells.
Question 2: What hemoglobin range is targeted when using ESA therapy in dialysis patients according to KDIGO guidelines?
- 8–9 g/dL
- 10–11.5 g/dL (Correct answer)
- 12–13 g/dL
- 13–14 g/dL
Correct answer: 10–11.5 g/dL
KDIGO guidelines recommend targeting hemoglobin between 10–11.5 g/dL with ESA therapy to improve quality of life while avoiding the increased cardiovascular risks associated with higher levels.
Question 3: IV iron supplementation is indicated in dialysis patients when ferritin is below what threshold despite ESA therapy?
- 100 ng/mL
- 200 ng/mL (Correct answer)
- 500 ng/mL
- 800 ng/mL
Correct answer: 200 ng/mL
IV iron is commonly indicated when serum ferritin is below 200 ng/mL or transferrin saturation is below 20%, suggesting functional iron deficiency limiting ESA response.
Question 4: Which phosphate binder is safe to use in dialysis patients with hypercalcemia?
- Calcium carbonate
- Calcium acetate
- Sevelamer hydrochloride (Correct answer)
- All calcium-containing binders
Correct answer: Sevelamer hydrochloride
Sevelamer is a non-calcium, non-aluminum phosphate binder that effectively lowers serum phosphorus without contributing to hypercalcemia.
Question 5: Cinacalcet (Sensipar) is used in dialysis patients primarily to treat which condition?
- Hyperkalemia
- Secondary hyperparathyroidism with elevated PTH (Correct answer)
- Anemia of chronic kidney disease
- Dialysis-related amyloidosis
Correct answer: Secondary hyperparathyroidism with elevated PTH
Cinacalcet is a calcimimetic that increases the parathyroid gland's sensitivity to calcium, suppressing PTH secretion and treating secondary hyperparathyroidism.
Question 6: Which antihypertensive class is preferred for dialysis patients with diabetic nephropathy to slow residual kidney disease progression?
- Calcium channel blockers
- Beta-blockers
- ACE inhibitors or ARBs (Correct answer)
- Alpha-blockers
Correct answer: ACE inhibitors or ARBs
ACE inhibitors and ARBs block the renin-angiotensin-aldosterone system, reducing intraglomerular pressure and proteinuria, thereby slowing CKD progression.
CDN Renal Pharmacology for Dialysis Nurses 1
Which erythropoiesis-stimulating agent (ESA) is most commonly used to treat anemia of chronic kidney disease in dialysis patients?