We suggest that Hb concentration should be monitored every 2-4 weeks in the correction phase or after a dose adjustment and every 1-3 months for stable individuals in the maintenance phase of ESA treatment. More frequent monitoring will depend on clinical circumstances. (2B)
Rationale
It is important to closely monitor Hb response to treatment to monitor for possible adverse events and plan ESA dose modification. More frequent Hb monitoring may be needed for people with unstable Hb, out of target Hb level, anticipated Hb drop due to blood loss/haemolysis, infection or suboptimal dialysis. The response to ESA therapy varies widely between different patient groups and individuals within those groups. In addition, an individual‘s response can vary greatly dependent on other clinical variables. During ESA initiation therapy, after drug dose adjustments or changes in an individual‘s clinical condition, more frequent monitoring is advised in order that under-treatment (ongoing anaemia) and overtreatment (rapidly rising Hb/hypertension or polycythaemia) may be avoided (1-3).
References
- National Collaborating Centre for Chronic Conditions, Royal College of Physicians. Chronic kidney disease: assessment and management. 2021. National Institute for Clinical Excellence.
- Locatelli F, Aljama P, Barany P et al. Revised European best practice Guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant 2004; 19 Suppl 2: ii1 47.
- NKF-K/DOQI Clinical Practice Guidelines for Anaemia of Chronic Kidney Disease: update 2000. Am J Kidney Dis 2001; 37: S182-S238.