rhEPO for the Treatment of Erythropoietin Resistant Anemia in Hemodialysis Patients – Risks and Benefits

Anemia is a common complication in hemodialysis (HD) patients, mainly due to the insuffi‐ cient production of erythropoietin (EPO) by the failing kidneys [1]. Anemia itself can worsens cardiac function, cognitive function, exercise capacity and quality of life, and it has been independently associated with increased mortality and progression of renal disease [2, 3]. A successful management of anemia is, therefore, crucial, as it may improve clinical outcome. The introduction of recombinant human EPO (rhEPO) therapy to treat anemia of chronic kidney disease (CKD) patients reduced anemia, improving patients’ quality of life [3]. There is, however, a marked variability in the response to this therapy and 5-10% of patients develop resistance to rhEPO therapy [4]. Resistance to rhEPO therapy has been associated to inflam‐ mation, oxidative stress and “functional” iron deficiency, as major causes.