What effect can iron supplementation have when given with ESA?

Iron supplementation can enhance hemoglobin response when given with an erythropoiesis-stimulating agent (ESA), making this the correct answer. ESAs are medications that stimulate the production of red blood cells and are often used in patients with chronic kidney disease or other conditions leading to anemia. However, for these agents to be effective, sufficient iron stores are essential since iron is a critical component of hemoglobin, the molecule responsible for oxygen transport.

When a patient receives ESA therapy, their body’s demand for iron increases as more red blood cells are produced. Supplementing with iron ensures that this demand is met, thereby improving the overall efficacy of the ESA treatment. As a result, patients may experience a more significant increase in hemoglobin levels, ultimately leading to improved oxygen delivery to tissues and better overall health outcomes.

The other options do not accurately reflect the effects of iron supplementation when used in conjunction with ESA. Hyperkalemia, increased blood pressure, and worsened fluid retention are not direct outcomes of iron supplementation. In fact, the primary role of iron in this context is to support the response to ESAs rather than contribute to these complications.