A patient with chronic renal failure who is on dialysis receives an ESA. The nurse caring for this patient during dialysis notes that the patient's hemoglobin is 10.9 gm/dL, up from the 10.2 gm/dL recorded 2 weeks ago. The patient's blood pressure is 120/80 mm Hg. The nurse will contact the provider to suggest:

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Patients with CRF on dialysis can benefit from heparin to prevent clotting in the dialysis machine. The risk of clotting is greatest when the hemoglobin level exceeds 11 gm/dL. There is no indication for an antihypertensive drug, because the patient's blood pressure is normal. The patient's hemoglobin is less than 12 gm/dL and has risen less than 1 gm/dL in 2 weeks; therefore, neither reducing the ESA dose nor stopping the ESA is indicated.

A Patient with Chronic Renal Failure Who Is on Dialysis