Current issues in anaemia management
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:
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Infection/inflammation (eg, access infections, surgical inflammation, AIDS, systemic lupus erythematosus)
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Chronic blood loss
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Osteitis fibrosa
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Aluminum toxicity
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Haemoglobinopathies (eg, alpha and beta thalassaemias, sickle cell anaemia)
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Folate or vitamin B12 deficiency
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Multiple myeloma
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Malnutrition
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Haemolysis.
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: June 2008.
