What must be given alongside ESA for effective treatment?

For effective treatment with erythropoiesis-stimulating agents (ESAs), iron supplementation is essential. ESAs work by stimulating the production of red blood cells in the bone marrow, but the body needs sufficient iron to produce hemoglobin, which is a critical component of red blood cells. Without adequate iron, the production of hemoglobin is impaired, potentially leading to suboptimal responses to ESA therapy and persistently low hemoglobin levels.

Iron deficiency can occur quite commonly in patients receiving ESAs, especially those with chronic kidney disease or undergoing certain treatments. Monitoring of iron levels and supplementation when necessary is integral to optimizing the treatment outcomes of patients on ESAs.

In contrast, while vitamins like Vitamin D and minerals like Calcium and Magnesium can be important for overall health, they do not play the same direct role in the activation and efficacy of ESA therapy as iron. Therefore, ensuring sufficient iron levels will directly influence the effectiveness of ESA treatment, making iron the crucial element that must accompany ESA therapy.