Benefits and risks of erythrocyte-stimulating agents

Table 2 Erythrocyte-stimulating agents hyposensitivy (Kidney Disease Improving Global Outcomes Guideline 2012)[20]

Initial ESA hyporesponsiveness

Classify patients as having ESA hyporesponsiveness if they have no increase in Hb concentration from baseline after the first month of ESA treatment on appropriate weight-based dosing

In patients with ESA hyporesponsiveness, avoid repeated escalations of the ESA dose beyond double the initial weight-based dose

Subsequent ESA hyporesponsiveness

Classify patients as having acquired ESA hyporesponsiveness if after treatment with stable doses of ESA, they require two increases in ESA doses up to 50% beyond the dose at which they had been stable in an effort to maintain a stable Hb concentration

In patients with acquired ESA hyporesponsiveness, avoid repeated escalations in ESA dose beyond double the dose at which they had been stable

Management of poor ESA responsiveness

Evaluate patients with either initial or acquired ESA hyporesponsiveness and treat for specific causes of poor ESA response

For patients who remain hyporesponsive despite the correction of treatable causes, accounting for relative risks and benefits: decline in Hb concentration; continuing ESA if needed to maintain Hb concentration, with due consideration of the doses required; blood transfusions

ESA: Erythrocyte-stimulating agent; Hb: Hemoglobin.