Use of erythropoietic stimulating agents in the setting of renal disease

  • David A. Goodkin
Part of the Milestones in Drug Therapy book series (MDT)


As kidneys fail, their capacity to produce erythropoietin (EPO) typically diminishes. This deficiency of EPO is the primary etiology of the progressive anemia of chronic kidney disease (CKD). Hemoglobin concentration decreases in association with the increase in blood urea concentration (Fig. 1) and the decline in creatinine clearance (Fig. 2) of progressive renal failure [1]. The anemic state is exacerbated by a shortened red blood cell lifespan and bone marrow resistance to EPO in the setting of advanced uremia. Bleeding time is prolonged, as well, and gastrointestinal blood loss is not uncommon. In addition, dialytic therapy may consume red cells, due to repeated diagnostic phlebotomy, hemolysis caused by the hemodialysis pump, bleeding associated with hemodialysis needle insertion and removal, recurrent anticoagulation, and incomplete return of blood from the hemodialysis filter and bloodlines at the end of a treatment. Inflammatory cytokines and nutritional deficiencies may worsen the anemia of CKD.


Chronic Kidney Disease Hemodialysis Patient Darbepoetin Alfa Recombinant Human Erythropoietin Nephrol Dial Transplant 
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Copyright information

© Birkhäuser Verlag/Switzerland 2009

Authors and Affiliations

  • David A. Goodkin
    • 1
    • 2
  1. 1.Goodkin Biopharma ConsultingLLCBellevueUSA
  2. 2.Arbor Research Collaborative for HealthAnn ArborUSA

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