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Ovid: Oxford Handbook of Dialysis

Editors: Levy, Jeremy; Morgan, Julie; Brown, Edwina Title: Oxford Handbook of Dialysis, 2nd Edition Copyright ©2004 Oxford University Press > Table of Contents > Part 8 – Complications of ESRD: anaemia > Erythropoietin: failure to respond (resistance) Erythropoietin: failure to respond (resistance) Most common cause is iron deficiency, often induced by the rise in Hb. Other causes include:

  • inadequate dosing;
  • concurrent infection/inflammation;
  • compliance;
  • hyperparathyroidism;
  • bone marrow fibrosis;
  • occult malignancy;
  • aluminium;
  • malnutrition;
  • inadequate dialysis;
  • haemoglobinopathies;
  • other haematinic deficiency;
  • other bone marrow disorders, e.g. myelodysplasia;
  • PRCA;
  • blood loss;
  • haemolysis;
  • ACE inhibitors;
  • carnitine deficiency.

True resistance (to 500–900units EPO/kg/week or 1.5µg/week darbepoietin in iron replete patients) is rare. Relative resistance quite common. Adequate doses of EPO should induce an increase in reticulocytes in the blood. Iron store should be maintained (ferritin 400–800 ng/ml) with regular iron. Increasing evidence that regular intravenous iron reduces requirements for EPO.

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