Fast Five Quiz: Management of Chronic Kidney Disease Anemia

Pradeep Arora, MD


April 19, 2022

According to the 2012 KDIGO clinical practice guideline on anemia in CKD, ESA hyporesponsiveness, or resistance, is the inability to achieve or maintain desirable hemoglobin despite higher than usual doses of ESAs. The most common cause of resistance is iron deficiency anemia. Guidelines recommend that iron administration in anemic patients with CKD with TSAT is < 30% and with serum ferritin is < 500 ng/ml. However, a 2019 KDIGO Controversies Conference determined that these parameters are not reliable for estimating iron stores or predicting therapeutic response, suggesting an individualized approach to iron supplementation. Correction with oral, or preferably, IV iron supplementation has consistently demonstrated improvement in erythropoietic response to ESA treatment. Prior to administration, active infection, the second most common cause of ESA resistance, should be excluded.

Although less common, other causes of ESA hyporesponsiveness include hyperparathyroidism, bone marrow aplasia, and severe malnutrition.

Learn more about CKD anemia management.


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