Background: Many factors can alter the response to erythropoietin treatment and approximately 5-10% of patients present an evident resistance in response to erythropoietin therapy. These include: iron deficiency, inflammation, infections, malignancy, dialysis, blood loss, hyperparathyroidism, aluminum toxicity and vitamin B12 or folate deficiencies. Objective: To evaluate and search for causative factors that predispose to Anemia resistance to erythropoietin therapy in End stage renal failure patients on regular hemodialysis. Patients and methods: This is descriptive prospective study enrolling 350 patients with End stage renal disease on regular hemodialysis, during January 2019 to January 2020 at Al-Emamain Al-Kadumian Medical City / Nephrology unit. 117 (44 female and 73 male) patients enrolled in this study whom met the inclusion criteria: Hgb level below 11 mg / dl despite adequate erythropoietin dose, regular adequate HD, Iron and folic acid supplementation. Amonthly bases measurement of CBC,
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