Assessing hyporesponse to Epoetin alfa: an algorithm approach: case study of the anemic patient.

Nephrology nurses who manage the anemia of end-stage renal disease (ESRD) are often responsible for monitoring, assessing, and intervening to maintain hemoglobin (Hb) and hematocrit (Hct) levels within their facility target range. Consistency in anemia-related outcomes is sometimes compromised when patients exhibit hyporesponse to Epoetin alfa therapy-defined as a temporary or chronic Hb/Hct level below the target range. Early detection of hyporesponse and correction of conditions that are affecting erythrocyte development can sometimes be delayed if clinicians are unable to promptly identify a causative etiology. This article reviews a hyporesponse algorithm worksheet that nurses can use to identify the cause(s) of hyporesponse and guide clinical decision making.