American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a critical threshold for hemoglobin levels that indicates the need for ESA in CKD patients?

1. 7 g/dL

2. 9 g/dL

3. 10 g/dL

4. 11 g/dL

The correct answer is: 10 g/dL

In patients with chronic kidney disease (CKD), erythropoiesis-stimulating agents (ESAs) are commonly used to manage anemia typically associated with the disease. The critical threshold for initiating ESA therapy is a hemoglobin level of 10 g/dL. This recommendation is based on clinical guidelines that suggest aiming for this specific hemoglobin concentration to effectively relieve symptoms associated with anemia, such as fatigue and decreased exercise capacity, and to improve the quality of life. Initiating ESA therapy at this threshold is important because it balances the potential benefits of increasing hemoglobin levels and the risks associated with higher levels of hemoglobin, such as cardiovascular events. It supports the concept of matching treatment with the patient's needs while avoiding extensive interventions when they are not necessary. For patients with hemoglobin levels lower than 10 g/dL, starting ESA has been shown to be beneficial in most cases. In contrast, levels above 10 g/dL do not typically warrant the initiation of ESA therapy, unless there are specific clinical considerations or individualized patient scenarios that suggest otherwise. This information ensures that healthcare providers can make informed decisions about appropriate anemia management in CKD, tailoring treatment to maximize patient outcomes while minimizing potential risks.