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Erythropoiesis-stimulating agent (ESA) dosing

Drug dosing reference for erythropoiesis-stimulating agents in pediatric patients, specifically for the treatment of anemia in chronic kidney disease.

Different indications may have different typical doses/ranges. These algorithms are general guides, not rules; individual circumstances may warrant deviation from the algorithm.

Epoetin alfa (EPO) (Epogen®, Procrit®) & epoetin alfa-epbx (Retacrit®)

  • For patients on ESA, maintain transferrin saturation >20% and ferritin >100 ng/mL
    • If necessary, supplement with oral iron (or IV iron in patients on
      )

tip

Consider rounding EPO dose to nearest 100 units for easier administration.

Initial dosing for EPO

Algorithm for initiating erythropoietin in pediatric patients
Initiating erythropoietin (EPO) therapy
No
Yes
Pre-EPO Hb <10 g/dL?
Avoid EPO
No
Yes
Concern for/known oncologic process?
No
Yes
Iron replete?
No
Yes
Hypertension controlled?
Replenish iron stores
Manage blood pressure
if on
HD/CKRT
Route?
Intravenous (IV)
Subcutaneous (SQ)
No
Yes
Age ≥5 years?
No
Yes
Hb ≥9 g/dL?
100 U/kg/dose 2x/week
50 U/kg/dose 2x/week
75 U/kg/dose 3x/week
100 U/kg/dose 3x/week
Repeat Hb 2 weeks
Advance to maintenance therapy

note

EPO may be initiated for a hemoglobin (Hb) of ≥10.0 g/dL (100 g/L) if a patient has a quality of life benefit at this higher Hb concentration. However, most patients do not experience symptoms above this level. Additionally, it may be a challenge to get insurance coverage for EPO in this circumstance.

Maintenance dosing for EPO

Target hemoglobin concentration

  • KDIGO recommends a hemoglobin (Hb) target of 11.0-12.0 g/dL (110-120 g/L) in children with CKD
  • KDOQI (US) recommends a target of 11.0-13.0 g/dL in children with CKD
Algorithm for maintenance erythropoietin dosing in pediatric patients
Maintenance erythropoietin (EPO) therapy
Yes
No
Concern for/known oncologic process?
Discontinue EPO
Yes
No
Hypertension controlled?
Yes
No
Hospitalized due to surgery/ infection?
Current Hb? (g/dL)
↑ by 25%

Repeat Hb 2 weeks

↓ by 25%

Repeat Hb 1 mo

<9
13.1-13.5
9.0-9.9
10-10.9
11-12
12.1-13
13.6-14
14.1-15
>15
↑ by 30%

Repeat Hb 2 weeks

↑ by 25%

Repeat Hb 2 weeks

No
Yes
Hb ↑
by ≥1 in past month?
Yes
No
Hb ↓
by ≥1 in past month?
Yes
No
Hb ↓
by ≥1 in past month?
Yes
No
Hb ↑
by >1 in past month?
↓ by 30%

Repeat Hb 1 week

Hold EPO until Hb <14
Hold EPO x3 doses
↑ by 25%

Repeat Hb 1 mo

No change

Repeat Hb 1 mo

↑ by 25%

Repeat Hb 1 mo

No
Yes
Hb ↑ by
≥0.5 in past month?
↓ by 10%

Repeat Hb 1 mo

No
Yes
Hb ↑ or
stable in past month?
↓ by 50%

Repeat Hb 1 week

↓ by 25%

Repeat Hb 2 weeks

Evaluate for conditions affecting erythropoietin responsiveness

Darbepoetin alfa (Aranesp®)

stub

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Initial dosing for darbepoetin

Patients on dialysis: 0.45 mcg/kg weekly

Patients not on dialysis: 0.75 mcg/kg every other week