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
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If necessary, supplement with oral iron (or IV iron in patients on
)
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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
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
Darbepoetin alfa (Aranesp®)
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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