Resistance to Erythropoietic Stimulating Agents in Pre-Dialysis Elderly Patients
Pp. 98-114 (17)
Ana Cabrita, Ana P. Silva and Pedro L. Neves
Anemia is a very frequent clinical finding in elderly people. There are several
factors contributing to this condition, namely nutritional deficiencies, inflammation and
chronic renal insufficiency. The etiology of chronic kidney disease related anemia is
multifactorial, but a relative decrease of erythropoietin production is a major cause.
Accordingly, the use of erythropoietic stimulating agents (ESA) is the cornerstone of
the therapy in pre-dialysis elderly patients. Resistance or hyporesponsiveness to the
treatment happens when the ESA dose needed to produce an otherwise expected
increase in hemoglobin is particularly high. Iron deficiency is the commonest cause of
resistance to ESA. Inflammation, malnutrition, hyperparathyroidism, drugs and vitamin
B12 and folate deficiencies are other important causes of ESA resistance. The clinical
investigation of ESA hyporesponsiveness is mandatory, since the correction of chronic
kidney disease related anemia is cost saving and decreases the morbidity and mortality
in the long term.
Erythropoietin, pre-dialysis, elderly, anemia, kidney disease,
Nephrology Department, Hospital de Faro, Rua Leão Penedo, 8000 Faro, Portugal.