**8. Conclusion**

Hyporesponse to ESA therapy has well-known negative outcomes in hemodialysis patients. A wise approach is to target the underlying causes before the up-titration of the ESA dose. There is insufficient evidence of adjuvant therapy and adverse effects of exogenous ESA as well. The discovery of new areas of hepcidin and HIF pathway

*Hyporesponsiveness to Erythropoietin-Stimulating Agents: Possible Solutions DOI: http://dx.doi.org/10.5772/intechopen.109988*

paved the way for the possible development of novel therapeutic agents, including EPO gene therapy, hepcidin antagonists, and better-planned tackling HIF stabilizers. More dedicated efforts are still required for better-planned tackling of a problem that has continued for more than two decades.
