Which of the following is the most appropriate next step in the management of this patients anemia?
A 70-year-old white female with type 2 diabetes mellitus and stage IV chronic kidney disease has a hemoglobin of 11.8 g/dL on routine laboratory testing. She denies any worsening fatigue or new complaints. Peripheral smear reveals a normocytic anemia with an MCV of 85 fL. Iron studies show a normal FE, TIBC, and a normal ferritin (220 ng/mL). Screening colonoscopy performed 6 years ago was normal.
1. Give 100 mg of intravenous dextran B. Give erythropoietin 50 U/kg subcutaneously three times weekly C. Follow a hemoglobin level every 6 months for further decline D. Schedule esophagogastroduodenoscopy with small bowel follow-through
Follow a hemoglobin level every 6 months for further decline-the predominant cause of anemia in renal disease is a deficiency of erythropoietin production by the diseased kidneys. erythropoietin is the standard treatment for patients with renal disease and moderate to severe anemia. however, recent studies have shown an increased mortality in patients with anemia because of renal disease treated with esas to target hemoglobins of 13 to 15 g/dl compared with 11 to 12.5 g/dl. in general, target hemoglobin levels of 11 to 12 g/dl are goal levels when treating with esas. patients with similar hemoglobin levels off therapy do not need to be initiated on treatment.