Editorials

Poor response to erythropoietin

Recombinant human erythropoietin was licensed for the treatment of renal anaemia five years ago, and over 90% of patients respond to it.¹ But the few who do not are important both in clinical and financial terms: a 70 kg man failing to respond to a dose of 200 U/kg/week currently costs the NHS pounds sterling6500 a year.

The definition of a poor response to erythropoietin is arbitrary. As most patients with renal anaemia respond to 75-150 U/kg/week any such patient showing a rise in haemoglobin concentration of less than 10 g/l/month despite a dose of greater than 200 U/kg/week may be classed as a "poor responder." Several factors may be responsible: important causes include iron deficiency,^{2 3} blood loss,⁴ infection, and inflammatory conditions, including malignancy.^{5 6} Other causes include hyperparathyroidism with marrow fibrosis,⁷ aluminium toxicity,⁸ vitamin B-12 or folate deficiency,⁹ haemolysis,¹⁰ marrow dysfunction,¹¹ red cell enzyme . . . [Full text of this article]

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Relevant Article

Poor response to erythropoietin

Judith Strachan, Laura Fleming, John Dick, Iain Henderson, Callum Fraser, Michael Jones, and Ellon McGregor
BMJ 1995 311: 633. [Extract] [Full Text]

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• Andrews, P. A., Green, R., Conrad, M. E., Umbreit, J. N., Andrews, N. C. (2000). Disorders of Iron Metabolism. NEJM 342: 1293-1294 [Full text]  
• BESARAB, A., FRINAK, S., YEE, J. (1999). An Indistinct Balance: The Safety and Efficacy of Parenteral IronTherapy. J. Am. Soc. Nephrol. 10: 2029-2043 [Full text]  
• Urena, P., Petrover, M., Levin, N. W., Gotch, F., Malhotra, D., Tzamaloukas, A. H., Ballinger, A. B., Fairclough, P. D., Clark, M. L., Farthing, M. J.G., Kotanko, P., Ifudu, O., Feldman, J., Friedman, E. A. (1996). Intensity of Hemodialysis and Response to Erythropoietin. NEJM 334: 1669-1671 [Full text]  
• Strachan, J., Fleming, L., Dick, J., Henderson, I., Fraser, C., Jones, M., McGregor, E. (1995). Poor response to erythropoietin. BMJ 311: 633a-633 [Full text]