Chapter 6

Resistance to Erythropoietic Stimulating Agents in Pre-Dialysis Elderly Patients

Ana Cabrita, Ana P. Silva and Pedro L. Neves


Anemia is a very frequent clinical finding in elderly people. There are several factors contributing to this condition, namely nutritional deficiencies, inflammation and chronic renal insufficiency. The etiology of chronic kidney disease related anemia is multifactorial, but a relative decrease of erythropoietin production is a major cause. Accordingly, the use of erythropoietic stimulating agents (ESA) is the cornerstone of the therapy in pre-dialysis elderly patients. Resistance or hyporesponsiveness to the treatment happens when the ESA dose needed to produce an otherwise expected increase in hemoglobin is particularly high. Iron deficiency is the commonest cause of resistance to ESA. Inflammation, malnutrition, hyperparathyroidism, drugs and vitamin B12 and folate deficiencies are other important causes of ESA resistance. The clinical investigation of ESA hyporesponsiveness is mandatory, since the correction of chronic kidney disease related anemia is cost saving and decreases the morbidity and mortality in the long term.

Total Pages: 98-114 (17)

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