ABSTRACT
Anemia has long been recognized as a significant comorbidity in patients with chronic renal failure (CRF). With growing number of Americans developing chronic renal insufficiency (CRI) and progression to end-stage renal disease (ESRD), financial resources dedicated to treating the anemia of renal failure with recombinant human erythropoietin (rHuEPO) have been further taxed. There is significant patient variability in rHuEPO dose response. Approximately 90% of patients treated with rHuEPO respond with correction of anemia, whereas approximately 10% fail to attain target hemoglobin levels despite the use of very high doses (1,2). A relative
deficiency of erythropoietin (EPO) is considered the major contributor to the anemia of CRF, however, there are a number of other potentially modifiable conditions that contribute to anemia (Table 1) which can alter the therapeutic response to rHuEPO therapy. Iron deficiency, chronic inflammatory
Table 1 Factors that May Contribute to Anemia of Renal Disease
conditions, and under-dosing are common reasons for poor response to rHuEPO therapy. Blood loss, hemolysis, hyperparathyroidism, vitamin B12 or folate deficiency, therapy with angiotensin converting enzyme (ACE) inhibitors, carnitine deficiency, hemoglobinopathies, or antibodies directed against rHuEPO are other less common reasons for EPO resistance (3). This chapter will review the epidemiology of renal disease and anemia in the United States, the unique pathophysiology of anemia associated with renal failure and the clinical benefits of and trends in the use of rHuEPO since its introduction in 1989.
