Erythropoiesis-stimulating agent, commonly abbreviated ESA, an agent similar to the cytokine (erythropoietin) that stimulates red blood cell production (erythropoeisis). ESAs, structurally and biologically, are similar to naturally occurring protein erythropoietin.
- Erythropoietin (Epo)
- Epoetin alfa (Procrit/Epogen)
- Epoetin beta (NeoRecormon)
- Darbepoetin alfa (Aranesp)
- Methoxy polyethylene glycol-epoetin beta (Mircera)
ESAs are used to maintain hemoglobin at the lowest level that both minimizes transfusions and best meets a person's needs. Medical speciality professional organizations do not recommend the use of ESAs in people with chronic kidney disease (CKD) who have hemoglobin levels greater than 10 g/dL and do not have anemia symptoms.
There is no evidence that one agent is better than another in the setting of CKD.
Causes of ineffectiveness
- Iron status
- Occult blood loss
- Vitamin B12 or folate deficiency
- Infection and inflammation
- Inadequate dialysis
- Aluminum toxicity
- Patient adherence
- Primary disease activity
- Transplant rejection
- Pure red cell aplasia
- Aapro, M. S.; Link, H. (2008). "September 2007 Update on EORTC Guidelines and Anemia Management with Erythropoiesis-Stimulating Agents". The Oncologist 13: 33–36. doi:10.1634/theoncologist.13-S3-33. PMID 18458123.
- American Society of Nephrology, "Five Things Physicians and Patients Should Question" (PDF), Choosing Wisely: an initiative of the ABIM Foundation (American Society of Nephrology), retrieved August 17, 2012
- Palmer, SC; Saglimbene, V; Mavridis, D; Salanti, G; Craig, JC; Tonelli, M; Wiebe, N; Strippoli, GF (8 December 2014). "Erythropoiesis-stimulating agents for anaemia in adults with chronic kidney disease: a network meta-analysis.". The Cochrane database of systematic reviews 12: CD010590. doi:10.1002/14651858.CD010590.pub2. PMID 25486075.
- Burtis, C.A.; Ashwood, E.R. and Bruns, D.E. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th Edition. Elsevier. pp 1554
- Jenkins, John K. (2007-06-26). "Congressional Testimony: Erythropoiesis-Stimulating Agents (ESA)". News & Events. FDA. Retrieved 2010-02-25.