A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin level of 7 g/dL. The most therapeutic pharmacologic intervention would be to administer:

• A. Epoetin alfa (Epogen)
• B. Vitamin B12
• C. Iron sucrose
• D. Folic acid

Answer: (A)

Chronic kidney disease reduces the kidneys’ production of erythropoietin, leading to anemia. The most effective pharmacologic intervention is to administer epoetin alfa, a recombinant human erythropoietin, which directly stimulates the bone marrow to increase red blood cell production. This addresses the root cause of renal anemia in dialysis patients and typically lowers the need for transfusions, improving oxygen delivery to tissues.

Vitamin B12 or folic acid would only help if there were deficiencies in those vitamins, which isn’t the typical driver of anemia in this setting. Iron sucrose is important if iron stores are deficient, because iron is necessary for hemoglobin synthesis, but without adequate erythropoietic stimulation, iron alone won’t raise hemoglobin significantly. In practice, iron status is checked and corrected as needed to support epoetin alfa therapy, and monitoring is essential to avoid excessive rise in hemoglobin and hypertension.