الفهرس 
Chronic Kidney Disease (CKD)
Management of ESRDOnly 14 pages are availabe for public view
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Abstract
ESAs are widely utilized to manage anemia in patients with CKD. ESAs resistance is characterized by the inability to achieve or maintain target hemoglobin levels despite the administration of higher than usual doses, or by the need for progressively increasing doses to sustain hemoglobin concentrations. Although specific criteria for ESAs hyporesponsiveness remain poorly defined, it is commonly attributed to factors such as absolute and functional iron deficiency, infection or inflammation, inadequate dialysis, severe hyperparathyroidism and malignancy or hematologic disorders. Addressing ESAs hyporesponsiveness requires a systematic approach to identify and manage potential causes. This includes excluding iron deficiency and administering iron supplementation when necessary. It is also essential to ensure that patients are receiving adequate HD; modifications to the dialysis prescription may be required. Comprehensive physical examinations should be conducted to identify and address occult infections, with particular attention to thrombosed arteriovenous grafts. In patients with severe hyperparathyroidism, achieving optimal PTH levels through pharmacologic therapy or parathyroidectomy is a critical component of management.