CDN Anemia Management in Dialysis Patients 2

Question 1

What is the most common cause of ESA hyporesponsiveness (failure to achieve target hemoglobin despite adequate ESA doses) in dialysis patients?

Accepted Answer

Iron deficiency

Answer

Iron deficiency is by far the most frequent cause of ESA hyporesponsiveness because adequate iron supply is essential for the bone marrow to respond to ESA stimulation and synthesize hemoglobin.

Question 2

Which condition is an absolute contraindication to continued ESA therapy in a dialysis patient?

Accepted Answer

Confirmed pure red cell aplasia (PRCA) due to anti-EPO antibodies

Answer

Pure red cell aplasia caused by anti-EPO antibodies is an absolute contraindication because continuing ESA therapy will worsen PRCA and could be life-threatening; ESA must be permanently discontinued.

Question 3

How frequently should hemoglobin be monitored in stable hemodialysis patients receiving ESA therapy?

Accepted Answer

Monthly

Answer

Monthly hemoglobin monitoring is recommended for stable dialysis patients on ESA therapy to allow timely dose adjustments and detect trends before hemoglobin rises above or falls below target range.

Question 4

According to KDIGO guidelines, above what serum ferritin level should IV iron supplementation generally not be routinely administered due to risk of iron overload?

Accepted Answer

500 ng/mL

Answer

KDIGO 2012 guidelines recommend withholding routine IV iron when ferritin exceeds 500 ng/mL, as higher levels suggest adequate stores and raise concern for iron overload and toxicity.

Question 5

Which vitamin is routinely supplemented alongside ESA therapy in hemodialysis patients to support effective erythropoiesis?

Accepted Answer

Folic acid (Vitamin B9)

Answer

Folic acid is water-soluble and dialyzed out during each treatment; adequate folate is essential for DNA synthesis in proliferating red cell precursors, and deficiency impairs the response to ESA therapy.

CDN - Certified Dialysis Nurse Practice Test

CDN - Certified Dialysis Nurse Practice Test

CDN Anemia Management in Dialysis Patients 2