NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

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At what hemoglobin level should ESA therapy be initiated in CKD patients?

When Hgb < 8
When Hgb < 10
When Hgb > 11
When Hgb > 13

The correct answer is: When Hgb < 10

In CKD patients, ESA (Erythropoiesis-Stimulating Agent) therapy should be initiated when the hemoglobin (Hgb) level falls below 10 g/dL. This is because starting ESA therapy below this threshold can help manage anemia and improve quality of life in these patients by stimulating red blood cell production. Initiating therapy at higher hemoglobin levels, such as >11 or >13 g/dL, may increase the risk of adverse effects like thromboembolic events. Therefore, keeping the Hgb level target within a certain range is crucial for optimizing the benefits of ESA therapy in CKD patients.