A client with chronic kidney disease and anemia is prescribed erythropoiesis-stimulating agents (ESAs) as part of the treatment plan. The nurse educates the client about the importance of which parameter during ESA therapy?

A) This choice is incorrect because vitamin A deficiency does not cause megaloblastic anemia.

B) This choice is correct because megaloblastic anemia is typically caused by a deficiency of vitamin B12 or folic acid, which are essential for normal red blood cell production.

C) This choice is incorrect because vitamin C deficiency leads to scurvy, a condition unrelated to megaloblastic anemia.

D) This choice is incorrect because vitamin D deficiency can lead to conditions like rickets, but it does not cause megaloblastic anemia.

A) This choice is correct. Vitamin C enhances the absorption of non-heme iron (the type of iron found in plant-based foods and supplements), so increasing vitamin C intake can help improve iron absorption. This can help differentiate between iron-deficiency anemia (improved iron absorption with increased vitamin C) and anemia of chronic disease (improved iron absorption with decreased vitamin C intake).

B) This choice is incorrect because increasing folate intake may help with megaloblastic anemia caused by folate deficiency, but it does not directly differentiate between iron-deficiency anemia and other types of anemia.

C) This choice is incorrect because increasing vitamin B12 intake does not help differentiate between iron-deficiency anemia and other types of anemia.

D) This choice is incorrect because increasing protein intake is important for overall health but does not directly help differentiate between iron-deficiency anemia and other types of anemia.