A 63-year-old female with anemia secondary to chronic kidney disease is treated with epoetin alfa. What would be the next step in management after her hemoglobin reaches 10.5 g/dL?

The management of anemia in patients with chronic kidney disease often involves the use of erythropoiesis-stimulating agents like epoetin alfa. When the patient's hemoglobin reaches a target level, such as 10.5 g/dL, it suggests that the treatment is effective in stimulating red blood cell production. At this point, further increases in hemoglobin levels may not be necessary, and it is important to avoid the risks associated with excess erythropoiesis, which can include hypertension, thrombosis, and potential cardiovascular events.

Discontinuing epoetin alfa at this stage helps to ensure that the patient's hemoglobin remains within the target range without the risk of excessive levels. This approach aligns with clinical guidelines that recommend reevaluating the need for ongoing treatment once the hemoglobin has reached an acceptable target, allowing for careful monitoring and assessment of the patient's condition.

Continuing with the same dosing or increasing the dose would not be indicated since the patient has already reached the desired hemoglobin level, which can lead to complications. Initiating darbepoetin alfa, a longer-acting erythropoietin analog, is not necessary when the hemoglobin level is adequate. Thus, discontinuation of epoetin alfa is the most prudent and evidence-based