CDN Anemia Management in Dialysis Patients 3

Question 1

What is the primary mechanism by which erythropoiesis-stimulating agents (ESAs) treat anemia in dialysis patients?

Accepted Answer

Binding to EPO receptors on erythroid progenitors to stimulate red blood cell production

Answer

ESAs bind to erythropoietin receptors on bone marrow erythroid progenitor cells, triggering proliferation and differentiation into mature red blood cells, replacing the EPO the diseased kidneys can no longer produce.

Question 2

Which of the following best describes functional iron deficiency in dialysis patients?

Accepted Answer

Normal or elevated ferritin with low TSAT indicating inadequate iron mobilization

Answer

Functional iron deficiency occurs when iron stores appear adequate (normal/high ferritin) but iron cannot be mobilized rapidly enough to meet the demands of ESA-stimulated erythropoiesis, resulting in a low TSAT.

Question 3

A large clinical trial (TREAT) showed that targeting hemoglobin levels above 13 g/dL with ESA therapy in CKD patients significantly increased the risk of which adverse outcome?

Accepted Answer

Stroke and cardiovascular events

Answer

The TREAT trial demonstrated a significantly increased risk of stroke when darbepoetin alfa was used to target near-normal hemoglobin (≥13 g/dL), establishing that higher hemoglobin targets are harmful in this population.

Question 4

A dialysis patient has Hgb 9.6 g/dL, TSAT 26%, and ferritin 680 ng/mL while receiving ESA therapy. What is the most appropriate next step?

Accepted Answer

Investigate other causes of anemia such as occult bleeding, folate/B12 deficiency, or inflammation

Answer

With TSAT >20% and ferritin >500 ng/mL, iron deficiency is not the likely cause; the nurse should work with the provider to investigate other contributors such as GI blood loss, nutritional deficiencies, infection, or aluminum toxicity.

Question 5

Which diagnostic test is used to confirm the presence of anti-erythropoietin antibodies when pure red cell aplasia (PRCA) is suspected in a dialysis patient?

Accepted Answer

Anti-EPO antibody assay (ELISA)

Answer

An anti-EPO antibody assay (ELISA) detects neutralizing antibodies against erythropoietin to confirm the diagnosis of PRCA; bone marrow biopsy showing absent erythroid precursors is also required for definitive diagnosis.

CDN - Certified Dialysis Nurse Practice Test

CDN - Certified Dialysis Nurse Practice Test

CDN Anemia Management in Dialysis Patients 3