Benefits and risks of erythrocyte-stimulating agents

Table 3 Practical approach in the presence of erythrocyte-stimulating agents resintance (Kidney Disease Improving Global Outcomes Guideline 2012)[20]

Tests	Finding and action
Check adherence	If poor, attempt to improve (if self-injection)
Reticulocyte count	If > 130000/μL, look for blood loss or hemolysis: endoscopy, colonoscopy, hemolysis screen
Serum vitamin B12, folate	If low, replenish
Iron status	If low, replenish iron
Serum PTH	If elevated, manage hyperparathyroidism
Serum CRP	If elevated, check for and treat infection or inflammation
Underdialysis	If underdialyzed, improve dialysis efficiency
ACEi/ARB use	If yes, consider reducing dose or discontinuing drug
Bone marrow biopsy	Manage condition diagnosed, e.g., dyscrasia, infiltration, fibrosis

ACEi: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin-receptor blocker; CRP: C-reactive protein; PTH: Parathyroid hormone.