Henry Ford Hospital Medical Journal


N. Kevin Krane


The major factors responsible for the anemia of chronic renal failure are decreased erythropoietin (Ep) production, the presence of inhibitors of erythropoiesis, blood loss, and hemolysis. Ep, which is produced in the kidney, probably exerts its effect on the colony-forming units of the erythrocyte. Ep levels fall with worsening renal function (creatinine clearances in the range of 2-40 ml/min). but they rise to their highest levels in the immediate predialysis period, probably due to severe ischemia of both renal and extrarenal production sites. When patients are begun on hemodialysis, Ep levels fall, and the hematocrit rises. Erythropoietin therapy in the management of anemia of chronic renal failure is potentially a practical application of experimental studies.