Recommendation ID

Treatment of erythropoietic stimulating agents (ESAs) resistance in haemodialysis patients:- What is the most effective type of intervention to treat haemodialysis patients with ESA-resistant anaemia?

Any explanatory notes
(if applicable)

Why this is important:- Around 5% to 10% of patients with end-stage renal disease show resistance to ESAs. ESA hyporesponsiveness in chronic haemodialysis patients may be associated with increased morbidity and mortality. In addition, pre-transplantation ESA hyporesponsiveness is thought to be associated with increased kidney allograft failure and patient mortality. Studies have shown that immunosuppressants, antioxidants, anti-cytokine therapies and high-flux membranes vary in how
much they improve responsiveness to ESA therapy, but all the studies used a small sample size. There is inadequate evidence identified from available literature to inform recommending any intervention to improve ESA responsiveness.

Adequately powered randomised controlled trials are needed to establish the safety and efficacy of interventions to improve responsiveness to ESA therapy.

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