International

Resistance to therapy

 

A small percentage of patients treated with erythropoiesis-stimulating agents (ESAs) do not respond adequately to therapy¹. Inadequate response is defined as a failure to achieve target haemoglobin/haematocrit levels in the presence of adequate iron stores at a epoetin alfa or beta dose of 450 units/kg/wk IV or 300 units/kg/wk SC within 4 to 6 months, or failure to maintain target haemoglobin/haematocrit levels subsequently at that dose. Incomplete response to ESAs is most commonly a result of iron deficiency, but in patients without iron deficiency it can be a result of²:

• Infection/inflammation (eg, access infections, surgical inflammation, AIDS, systemic lupus erythematosus)
• Chronic blood loss
• Osteitis fibrosa
• Aluminum toxicity
• Haemoglobinopathies (eg, alpha and beta thalassaemias, sickle cell anaemia)
• Folate or vitamin B12 deficiency
• Multiple myeloma
• Malnutrition
• Haemolysis.

  

Next in this section (Risk of antibody-mediated PRCA)  

References:

1. National Collaborating Centre on Chronic Conditions (NCC-CC). Anaemia Management in Chronic Kidney Disease: National clinical guideline for management in adults and children. London: Royal College of Physicians, 2006.
2. National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for anaemia in chronic kidney disease. Available at: http://www.kidney.org/professionals/KDOQI/guidelines_anemia/index.htm
   Accessed on: January 25, 2007.