Recommendation ID

Treatment of erythropoietic stimulating agents (ESAs) resistance:- In people with chronic ESA-resistant anaemia of CKD, what is the clinical and cost effectiveness of
treating with high-dose ESA compared with blood transfusion?

Any explanatory notes
(if applicable)

Why this is important:- People with ESA hyporesponsiveness show evidence of increased morbidity and mortality compared with those who respond well to ESA therapy. Poor response to ESA therapy during the haemodialysis treatment period is thought to be associated with worse post-transplant long-term outcomes, including increased all-cause death and higher risk of graft failure. Little is known about the potential risks of maintaining people with CKD on high doses of ESA therapy while they are waiting for a kidney transplant. It is unclear whether high-dose ESA should be continued in people with ESA resistance in an attempt to limit the number of blood transfusions, or whether people should stop ESA treatment and be treated with transfusions alone. The adverse effects differ between the strategies and are likely to have implications for cost and quality of life.
Further research is needed to understand the clinical and cost-effectiveness of these 2 strategies. Long-term prospective observational or matched case-controlled studies are needed to assess the relative safety of large-dose ESA versus no ESA, with or without blood transfusions, on long-term patient and graft survival.

Source guidance details

Comes from guidance
Chronic kidney disease: managing anaemia
Date issued
June 2015

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No