Nephrol Dial Transplant (2001) 16: 50-55
© 2001 European Renal Association-European Dialysis and Transplant Association
Present and future strategies in the treatment of renal anaemia
Department of Renal Medicine, King's College Hospital, London, UK
Abstract
Recombinant human erythropoietin therapy has transformed the management of renal anaemia over the last decade or so. We have learned much about the optimum regimens for using this drug, including the route of administration, dosage frequency, use of iron supplementation, and management of poor response. Thus, dosage requirements of epoetin are generally lower if the drug is administered subcutaneously, and the most commonly used dosage frequency is two or three times weekly. The vast majority of patients respond very well to treatment, but 
5–10% of patients show some resistance to epoetin, the most common cause of which is iron deficiency. The presence of infection or inflammation and underdialysis are other important causes of a poor response to epoetin. There is increasing interest in treating renal anaemia at an earlier stage in the course of the disease, and there is much circumstantial evidence to support this strategy. This usually involves giving epoetin to pre-dialysis patients, and a study has also recently commenced to investigate the effects of preventing renal anaemia ever developing. Other erythropoietic substances are being developed, and the first of these to be ready for clinical use is novel erythropoiesis stimulating protein (NESP), which is an analogue of erythropoietin containing two extra N-linked carbohydrate side-chains. Other potential erythropoietic substances are still at the laboratory stage of development, but may be available for therapeutic use in the next decade or so.
Keywords: epoetin; epoetin resistance; erythropoietic substances; renal anaemia
Notes
Correspondence and offprint requests to: Iain C. Macdougall, Consultant Nephrologist, Renal Unit, King's College Hospital, East Dulwich Grove, London SE22 8PT, UK.
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