Erythropoietin-stimulating Agents in Chronic Kidney Disease: A Response to Hyporesponsiveness


Address correspondence to: Patrick S. Parfrey, Division of Nephrology, Memorial University, Newfoundland, Canada A1B 3V6, Tel.: 709-777-7261, Fax: 709-777-6995, or e-mail:


Hyporesponsiveness to erythropoietin stimulating agents occurs frequently, and may be observed at initiation of treatment or during maintenance therapy. An inverse relationship between hyporesponsiveness and incident cardiovascular events has been reported. It is related at least in part to co-morbidity and its occurrence requires a search for the cause. Treatment of anemia in hyporesponsive patients should be individualized, with consideration given to the indication for ESA therapy, the target hemoglobin for therapy, and maximal dose limitations.