RESISTANCE TO ERYTHROPOIETIN IN DIALYSIS PATIENTS - FACTORS THAT DECREASE ERYTHROPOIETIN RESPONSIVENESS

Recombinant human erythropoietin is very effective for the treatment o f anemia in end-stage renal disease. Some patients, however, require s ignificantly larger-than-normal doses of erythropoietin to reach or ma intain their target hematocrits. These erythropoietin-resistant patien ts often have an underlying, unrecognized disorder which, if corrected , can eliminate the erythropoietin resistance. These underlying disord ers include iron deficiency, aluminum toxicity, infection, inflammatio n, hyperparathyroidism and bone marrow disease. An approach to the dia gnosis and treatment of erythropoietin resistance in end-stage renal d isease is outlined.