Do you avoid ESAs in patients with end stage kidney disease who also have heart failure due to increased risk of stroke?  

If the question is whether I avoid ESAs in patients with ESKD who also have heart failure, the answer is no for several reasons. The warning in the ESA package insert regarding using ESAs with caution in patients with heart failure (HF) comes from the CHOIR study (Singh, et al., PMID 17108343) of no...

I don’t. I think if used wisely, the thrombotic risk of ESA’s is low. Furthermore, the improvement in hemoglobin would help these patients tremendously.