Anxo Fernández-Ferreiro 1,2 , Mara Lisbet Cabana-Carcasi 3 , Rafael Alonso-Valente 3 , Eduardo Echarri- Arrieta 1,2 , Sara Blanco-Dorado 1,2 , Andrea Luaces-Rodriguez 2 , Antón Fernández-Ferreiro 4 , Miguel González- Barcia 1,2 , María J Lamas 1,2* 1 Pharmacy Department, Xerencia de Xestión Integrada de Santiago de Compostela. Spain (SERGAS). 2 Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela. Spain (IDIS-ISCIII). 3 Nephrology Department, Xerencia de Xestión Integrada de Santiago de Compostela. Spain (SERGAS). 4 Clinical Analysis Department. Hospital Universitario Nuestra Señora de la Candelaria. Tenerife. Spain. (SCS). Abstract Background: The erythropoiesis-stimulating agents (ESAs) are commonly used in the management of anemia in patients with chronic kidney disease. Objective: The aim of this study is to identify the parameters that make it necessary to use ESAs in patients with chronic kidney disease in peritoneal dialysis program. Methods: A cross-sectional study of patients on peritoneal dialysis during one year was performed, analyzing the factors associated with the use of ESAs and its resistance. Results: 77.4% of the patients included in the study (n=53) were treated with erythropoiesis-stimulating agents. It has been observed that the main factors that trigger the administration of ESAs area prolonged time on peritoneal dialysis (29.96 months vs. 16.67 months), a decreased residual renal function (3.76 vs 18.17 ml/min) and a deficient nutritional status (albumin: 3.77 g/dl vs. 4.14 g/dl, prealbumin: 39.58 mg/dl vs 46.73 mg/dl), presenting statistically significant differences (p <0.005) in all the parameters indicated. Conclusions: Maintaining a residual renal function and a good nutritional status are key factors that avoid the use of ESAs. Factors Contributing to use of Erythropoiesis Stimulating Agents in Patients with Chronic Kidney Disease in Peritoneal Dialysis Program: a Cross-Sectional Study. Research Article Clinical Pharmacology and Translational Medicine © All rights are reserved by Maria J Lamas, et al. Introduction Treatment of symptomatic anemia associated with chronic kid- ney disease (CKD) is one of the indications of erythropoiesis-stimul- ating agents. Several studies have shown a satisfactory clinical respo- nse to the treatment with ESAs, since 90% of the patients achieved the objectives of the treatment [1]. These studies also indicate that ESAs have the same effectiveness in hemodialysis, continuous ambulatory peritoneal dialysis and patients in predialysis with chronic kidney disease [2]. Relative resistance to the effect of ESAs is a common problem in managing the anemia of patients with CKD [3]. ESA hyporesponsive- ness has been found to be associated with an increase in morbidity and mortality of patients on hemodialysis and peritoneal dialysis [4, 5]. It has been suggested that erythropoietin treatment itself can cause inflammation and high doses are associated with increased mortality. Therefore, the detection, treatment and management of resistance seem to be a better therapeutic option than simply increasing the dose [6]. There are different causes of resistance, which are interrelated. It has been shown that inflammatory conditions characterized by elevated tumor necrosis factor alpha (TNF-), interleukin 1 (IL-1), interleukin 6 (IL-6) and interferon gamma (IFN-γ) and others are related to an inadequate response to therapy [7, 8]. Inflammatory processes often trigger iron deficiency because the iron cannot be mobilized from the storage locations in the reticuloendothelial system. It is inhibited by both the proliferation and differentiation of erythroid progenitor cells, and thus the response to erythropoietin [9]. Ferritin values below 100 mg/dl and ferritin saturation <20% is one of the most frequent causes of ESAs resistance. Malnutrition is usually another trigger of resistance, the association between inflammation, malnutrition and anemia syndrome has been coined malnutrition- inflammation complex (MICS) [10, 11] and it is typically identified by concurrent elevations in inflammation markers and decreases in nutr- ISSN:2572-7656 *Address for Correspondence: Maria Jesus Lamas, PharmD, Pharmacy Department, Hospital Clinico Universitario de Santiago de Compostela. Calle A Choupana s/n Santiago c.p.15701 (Spain), Tel: + 34 981950918; E-mail: maria.jesus.lamas.díaz@sergas.es Received: March 22, 2017; Accepted: May 03, 2017; Published: May 05, 2017 Clin Pharmacol Transl Med, 2017 Volume 1(2): 38-43