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
- If necessary, supplement with oral iron (or IV iron in patients on
tipConsider rounding EPO dose to nearest 100 units for easier administration.
Initial dosing for EPO
noteEPO 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