Case management of the anemic patient: epoetin alfa--focus on osteitis fibrosa.

Most patients with anemia caused by end-stage renal disease respond well to Epoetin alfa therapy, but in a small number the hematocrit fails to rise as expected. A potential cause of suboptimal response is osteitis fibrosa. Understanding the pathophysiology, manifestations, diagnosis, and treatment for osteitis fibrosa helps nurses to identify this condition as a cause of resistance to Epoetin alfa and to manage patients appropriately.